Healthcare Provider Details

I. General information

NPI: 1598548042
Provider Name (Legal Business Name): SOUTH CENTRAL CINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 JEFFERSON ST SUITE 400
LAUREL MS
39440
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-426-4010
  • Fax: 601-426-4011
Mailing address:
  • Phone: 601-425-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANICE QUIN
Title or Position: DIRECTOR
Credential:
Phone: 601-399-6367