Organization
MISSISSIPPI ASTHMA AND ALLERGY CLINIC, P.A.
Active
Parent organization
MISSISSIPPI ASTHMA AND ALLERGY CLINIC, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSISSIPPI ASTHMA AND ALLERGY CLINIC, P.A.
Authorized official
DAVID L MOAK (PRACTICE ADMINISTRATOR)
(601) 354-4836
Entity
Organization
Contact information
Practice address
2886 SOUTH LAMAR BLVD, OXFORD, MS 38655-7905
(601) 354-4836
Mailing address
1513 LAKELAND DR, SUITE 101, JACKSON, MS 39216-4829
(601) 354-4836
(601) 354-2619
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
09 00008210
MS
Other
Enumeration date
03/09/2010
Last updated
08/19/2011
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