Organization
DIAMOND GROVE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA SMITH (BUSINESS OFFICE DIRECTOR)
(601) 581-9906
Entity
Organization
Contact information
Practice address
2311 HIGHWAY 15 S, LOUISVILLE, MS 39339-7071
(662) 779-0119
(662) 779-0126
Mailing address
PO BOX 848, LOUISVILLE, MS 39339-0848
(662) 779-0119
(662) 779-0126
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220411
—
MS
Enumeration date
03/16/2007
Last updated
08/22/2020
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