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General NPI Number Information
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NPI Number | 1033095617
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Entity Type | Organization
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Legal Business Name | RODGERS MEDICAL CLINIC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 630 NORTHWEST AVE
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City | DURANT
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State | MS
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Zip | 39063-3337
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Country | US
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Telephone | 662-653-3011
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Fax | 662-653-6423
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Provider Business Mailing Address
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Address Line | 13418 ATTALA ROAD 4101
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City | SALLIS
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State | MS
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Zip | 39160-5242
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Country | US
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Telephone | 601-613-7835
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | PHILLIP ERIC RODGERS
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Credential | NP
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Telephone | 601-613-7835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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