Organization
MOM 2 BE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA RENEE LACY M.D. (OWNER)
(662) 570-4991
Entity
Organization
Contact information
Practice address
449 WILKINS WISE RD, COLUMBUS, MS 39705-1756
(662) 570-4991
(662) 570-4992
Mailing address
449 WILKINS WISE RD, COLUMBUS, MS 39705-1756
(662) 570-4991
(662) 570-4992
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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