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General NPI Number Information
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NPI Number | 1104980432
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CLINIC OF NORTH MISSISSIPPI, P.L.L.C.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 7585 CLARINGTO COVE
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5834
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Country | US
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Telephone | 662-349-0200
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Fax | 662-349-1666
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Provider Business Mailing Address
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Address Line | 7585 CLARINGTON CV
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5656
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Country | US
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Telephone | 662-349-0200
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Fax | 662-349-1666
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. TERRI H. HENSON
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Credential | M.D.
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Telephone | 662-349-0200
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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 | 16501
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License Number State | MS
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