Organization
DRG FAYETTE PLLC
Active
Other names
Diversified Renal Group Fayette, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
TUNDE OLUTADE (MEMBER)
(601) 899-3340
Entity
Organization
Contact information
Practice address
225 COMMUNITY DRIVE, OFF HWY 61, FAYETTE, MS 39069
(601) 786-6676
(601) 786-6678
Mailing address
5903 RIDGEWOOD RD, SUITE 340, JACKSON, MS 39211-3700
(601) 899-3340
(601) 899-3343
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
MS
Other
Enumeration date
12/12/2007
Last updated
01/15/2008
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