Individual
LARA J TEAL CLEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MAGNOLIA SENIOR CARE, 3701 PETER QUINN DR, JACKSON, MS 39213
(601) 206-0901
(888) 240-6288
Mailing address
200 AMITY LN, BRANDON, MS 39047-7941
(601) 206-0901
(888) 240-6288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16858
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122664
—
MS
Enumeration date
06/24/2006
Last updated
05/25/2021
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