Healthcare Provider Details

I. General information

NPI: 1871540427
Provider Name (Legal Business Name): MCCLANAHAN AND VALLETTE SURGICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 5TH ST N
COLUMBUS MS
39705-2010
US

IV. Provider business mailing address

2600 5TH ST N
COLUMBUS MS
39705-2010
US

V. Phone/Fax

Practice location:
  • Phone: 662-241-4223
  • Fax: 662-241-4460
Mailing address:
  • Phone: 662-241-4223
  • Fax: 662-241-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number017780
License Number StateLA

VIII. Authorized Official

Name: RICHARD C VALLETTE
Title or Position: PARTNER
Credential: M.D.
Phone: 662-241-4223