Organization
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER K SULLIVAN M.D. (PRESIDENT/CEO)
(601) 499-0935
Entity
Organization
Contact information
Practice address
7731 OLD CANTON RD, SUITE B, MADISON, MS 39110-6114
(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
174400000X
Specialist
Primary
23304
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01212067
—
MS
Enumeration date
11/09/2016
Last updated
12/21/2016
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