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General NPI Number Information
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NPI Number | 1013039288
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Entity Type | Organization
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Legal Business Name | CARNAHAN CLINIC PLLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 7900 AIRWAYS BLVD BLDG A STE 6
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4113
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Country | US
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Telephone | 662-536-4646
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Fax | 662-536-4443
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Provider Business Mailing Address
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Address Line | 7900 AIRWAYS BLVD BLDG A STE 6
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City | SOUTHAVEN
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State | MS
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Zip | 38671
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Country | US
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Telephone | 662-536-4646
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Fax | 662-536-4443
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Authorized Official
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Title or Position | OWNER
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Name | WALTER E CARNAHAN
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Credential | D.O.
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Telephone | 662-536-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16014
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License Number State | MS
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