Organization
OLIVE BRANCH PRIMARY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN M TATE (OFFICE ADMINISTRATOR)
(662) 895-3700
Entity
Organization
Contact information
Practice address
7163 GOODMAN RD, OLIVE BRANCH, MS 38654-1904
(662) 895-3700
(662) 895-4886
Mailing address
1405 NOTTINGHAM DR, SOUTHAVEN, MS 38671-9474
(662) 349-0406
(662) 349-0406
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2014
Last updated
02/28/2014
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