Organization
SOUTH RIDGE FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLANA HEDGEPETH (OWNER)
(601) 477-2221
Entity
Organization
Contact information
Practice address
80 HAL CROCKER RD, ELLISVILLE, MS 39437-2089
(601) 477-2221
Mailing address
80 HAL CROCKER RD, ELLISVILLE, MS 39437-2089
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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