Healthcare Provider Details

I. General information

NPI: 1669609111
Provider Name (Legal Business Name): SOUTH CENTRAL CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JEFFERSON ST
LAUREL MS
39440
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-2273
  • Fax: 601-426-9637
Mailing address:
  • Phone: 601-425-7550
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHANCIE KREGER
Title or Position: DIRECTOR CLINIC SUPPORT
Credential:
Phone: 601-399-6152