Organization
RESERVOIR FAMILY MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES NAURICE CRENSHAW III MD (OWNER/PHYSICAN)
(601) 992-6511
Entity
Organization
Contact information
Practice address
1679 OLD FANNIN RD STE E, FLOWOOD, MS 39232-8101
(601) 992-6511
(601) 992-5684
Mailing address
1679 OLD FANNIN RD STE E, FLOWOOD, MS 39232-8101
(601) 992-6511
(601) 992-5684
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
09099
MS
Other
Enumeration date
05/17/2013
Last updated
05/29/2013
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