Healthcare Provider Details

I. General information

NPI: 1124470166
Provider Name (Legal Business Name): WARRINGTON CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 MARTIN LUTHER KING DR
MARKS MS
38646-1832
US

IV. Provider business mailing address

1024 MARTIN LUTHER KING DR
MARKS MS
38646-1832
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-3502
  • Fax: 662-326-2555
Mailing address:
  • Phone: 662-326-3502
  • Fax: 662-326-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number893145
License Number StateMS

VIII. Authorized Official

Name: MS. SONYA WALTERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-326-3500