Organization
AT HOME PRIMARY CARE OF MS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA DELORIS SLADE DNP, FNP (NURSE PRACTITIONER)
(601) 270-1009
Entity
Organization
Contact information
Practice address
295 ARCHIE SMITH RD, HATTIESBURG, MS 39402-9322
(601) 207-1009
Mailing address
295 ARCHIE SMITH RD, HATTIESBURG, MS 39402-9322
(601) 207-1009
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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