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General NPI Number Information
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NPI Number | 1164573176
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Entity Type | Organization
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Legal Business Name | WARRINGTON CLINIC, P.A.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 1022 MARTIN LUTHER KING DRIVE POB 289
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City | MARKS
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State | MS
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Zip | 38646
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Country | US
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Telephone | 662-326-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 MARTIN LUTHER KING DRIVE POB 289
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City | MARKS
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State | MS
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Zip | 38646
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Country | US
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Telephone | 662-326-3500
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. RICHARD EDWIN WALLER
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Credential | M.D.
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Telephone | 662-326-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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