Organization
THE MANE PHYSICIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAMALA CHISM (OWNER)
(769) 487-4187
Entity
Organization
Contact information
Practice address
94 SPAIN DRIVE, GRENADA, MS 38901
(769) 487-4787
Mailing address
428 HIGHWAY 6 E # 217, BATESVILLE, MS 38606-3000
(662) 262-5711
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/08/2020
Last updated
04/08/2020
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