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General NPI Number Information
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NPI Number | 1144529983
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Entity Type | Organization
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Legal Business Name | DELTA FAMILY MEDICAL SERVICES INC
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 1554 S COLORADO ST
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City | GREENVILLE
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State | MS
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Zip | 38703-7219
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Country | US
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Telephone | 662-334-8557
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Fax | 662-334-8565
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Provider Business Mailing Address
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Address Line | 164 BAYOU RD
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City | GREENVILLE
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State | MS
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Zip | 38701-7731
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Country | US
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Telephone | 662-334-8557
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Fax | 662-334-8565
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT NEAL SUARES JR.
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Credential | M.D.
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Telephone | 662-334-8557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20731
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License Number State | MS
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