Organization
PINE GROVE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CARSON (EXECUTIVE DIRECTOR)
(601) 955-1132
Entity
Organization
Contact information
Practice address
1134 BARNES RD, CANTON, MS 39046
(601) 761-9424
Mailing address
1134 BARNES RD, CANTON, MS 39046-0036
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
12/05/2024
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