Healthcare Provider Details

I. General information

NPI: 1760592182
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MEDICAL ARTS DR
CALHOUN CITY MS
38916-9721
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-1337
  • Fax: 662-628-1346
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD KIMBROUGH
Title or Position: MANAGER
Credential:
Phone: 662-377-4685