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Organization

SOUTHAVEN INTERNAL MEDICINE, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KANDIS P SLEDGE (OFFICE MANAGER)
(662) 349-1999
Entity
Organization

Contact information

Practice address
7680 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5304
(662) 349-1999
(662) 349-9734
Mailing address
7680 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5304
(662) 349-1999
(662) 349-9734

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015446
MS
Enumeration date
01/10/2007
Last updated
06/17/2010
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