Internal Medicine Clinic Of Canton, INC
Internal Medicine in Jackson, MS. Organization (NPI-2).
NPI number1669917068
StatusActive
Last updated in NPPESDec 21, 2016
Details
- NPI
- 1669917068
- Entity type
- Organization (NPI-2)
- Legal business name
- Internal Medicine Clinic Of Canton, INC
- Organization subpart
- No
- Enumeration date
- Dec 21, 2016
- Last updated
- Dec 21, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Practice location
1116 Forest AveJackson, MS 39206-3216
Phone 601-750-8376
Mailing address
Po Box 9178Russellville, AR 72811-9178
Phone 479-498-6700
Authorized official
Louis James Saddler
Owner
6017508376
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