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General NPI Number Information
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NPI Number | 1063639185
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Entity Type | Organization
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Legal Business Name | THE WREN CLINIC, PC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 874 BARNES CROSSING RD
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City | TUPELO
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State | MS
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Zip | 38804-0909
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Country | US
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Telephone | 662-891-2999
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Fax | 662-286-0106
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Provider Business Mailing Address
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Address Line | PO BOX 1530 DEPT 185
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1530
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Country | US
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Telephone | 662-891-2999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES M. WREN II
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Credential | D.O.
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Telephone | 662-891-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 14798
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License Number State | MS
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