Healthcare Provider Details

I. General information

NPI: 1528498532
Provider Name (Legal Business Name): SOUTH CENTRAL CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AVENUE B SUITE 300
ELLISVILLE MS
39437-2080
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-2226
  • Fax: 601-477-2236
Mailing address:
  • Phone: 601-425-7550
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA MORROW
Title or Position: DIRECTOR CLINIC SUPPORT
Credential:
Phone: 601-399-6167