Healthcare Provider Details

I. General information

NPI: 1811414378
Provider Name (Legal Business Name): SOUTH CENTRAL CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-2863
  • Fax: 601-649-9479
Mailing address:
  • Phone: 601-399-6169
  • Fax: 601-399-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA MORROW
Title or Position: DIRECTOR OF CLINIC SUPPORT
Credential:
Phone: 601-399-6367