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Organization

DELTA STATE UNIVERSITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ABBY HAVARD LAT (ASSISTANT AD/HEALTH & PERFROMANCE)
(662) 846-4280
Entity
Organization

Contact information

Practice address
1003 W SUNFLOWER RD, CLEVELAND, MS 38733-0001
(662) 846-4280
Mailing address
1003 W SUNFLOWER RD, CLEVELAND, MS 38733-0001
(166) 284-6428

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2255A2300X
Athletic Trainer

Other

Enumeration date
07/26/2011
Last updated
10/04/2021
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