Walley Clinic PA
Family Medicine in Waynesboro, MS. Organization (NPI-2).
NPI number1669463584
StatusActive
Last updated in NPPESFeb 27, 2008
Details
- NPI
- 1669463584
- Entity type
- Organization (NPI-2)
- Legal business name
- Walley Clinic PA
- Organization subpart
- No
- Enumeration date
- Oct 31, 2005
- Last updated
- Feb 27, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
920 Matthew DrSte A
Waynesboro, MS 39367-2567
Phone 601-735-2401 · Fax 601-735-5205
Mailing address
920 Matthew DrSte A
Waynesboro, MS 39367-2567
Phone 601-735-2401 · Fax 601-735-5205
Authorized official
Eletha Jane Jenkins
Ceo
6017352401
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