Organization
DRG FAYETTE PLLC
Active
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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