Organization
DESOTO FAMILY CARE CLINIC, PLLC
Active
Other names
Desoto Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
DIOSAN MANGUBAT POWELL (MSN)
(662) 510-5353
Entity
Organization
Contact information
Practice address
346 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 510-5353
(662) 510-0409
Mailing address
5248 GARNER LN, SOUTHAVEN, MS 38672-6016
(662) 510-5353
(662) 510-0409
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
901872
MS
Other
Enumeration date
08/11/2017
Last updated
03/10/2023
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