Healthcare Provider Details

I. General information

NPI: 1952658080
Provider Name (Legal Business Name): DILLIGARA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HIGHWAY 80 E
CLINTON MS
39056-5337
US

IV. Provider business mailing address

1001 HIGHWAY 80 E
CLINTON MS
39056-5337
US

V. Phone/Fax

Practice location:
  • Phone: 601-213-7436
  • Fax:
Mailing address:
  • Phone: 601-213-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateMS

VIII. Authorized Official

Name: JODY ADAMS
Title or Position: OWNER
Credential: CFNP
Phone: 601-213-7436