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General NPI Number Information
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NPI Number | 1043462195
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 551 AZALEA DR
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City | OXFORD
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State | MS
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Zip | 38655-7900
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Country | US
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Telephone | 662-234-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 740 NOTTINGHAM DR
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City | OXFORD
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State | MS
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Zip | 38655-4414
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Country | US
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Telephone | 662-816-6349
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | JEANNETTE SMITH CLEMENTS
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Credential | R.D.
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Telephone | 662-816-6349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D1035
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License Number State | MS
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