Organization
BROOKHAVEN MEDICAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH MICHELLE BROOKS M.D. (C.E.O.)
(901) 217-3480
Entity
Organization
Contact information
Practice address
218 S VICTORIA AVE, CLEVELAND, MS 38732-3234
(901) 217-3480
Mailing address
218 S VICTORIA AVE, CLEVELAND, MS 38732-3234
(901) 217-3480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17310
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124352
—
MS
Enumeration date
06/18/2006
Last updated
07/05/2010
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