Organization
AVALON MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY DRAPER (MEMBER)
(662) 424-9550
Entity
Organization
Contact information
Practice address
1413 W QUITMAN ST, IUKA, MS 38852-1130
(662) 424-9550
Mailing address
1413 W QUITMAN ST, IUKA, MS 38852-1130
(662) 424-9550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04352560
—
MS
Enumeration date
12/10/2009
Last updated
10/18/2011
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