Healthcare Provider Details

I. General information

NPI: 1679567556
Provider Name (Legal Business Name): NEW HOPE MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 LAKE LOWNDES RD
COLUMBUS MS
39702-9655
US

IV. Provider business mailing address

2110 LAKE LOWNDES RD
COLUMBUS MS
39702-9655
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-4940
  • Fax:
Mailing address:
  • Phone: 662-329-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateMS

VIII. Authorized Official

Name: LINDA LAMISON
Title or Position: PRESIDENT
Credential:
Phone: 662-329-4940