Organization
MISSISSIPPI CENTER FOR ADVANCED MEDICINE PC
Active
Other names
Mississippi Center for Advanced Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER SULLIVAN MD (PRESIDENT AND CEO)
(601) 863-9764
Entity
Organization
Contact information
Practice address
7731 OLD CANTON RD STE B, MADISON, MS 39110-6115
(601) 499-0935
(601) 499-0936
Mailing address
7731 OLD CANTON RD, SUITE B, MADISON, MS 39110-6114
(601) 499-0935
(601) 499-0936
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14837/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09587750
—
MS
01
—
2160699
PK
—
Enumeration date
05/09/2016
Last updated
10/05/2016
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