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General NPI Number Information
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NPI Number | 1205237849
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Entity Type | Organization
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Legal Business Name | DELTA HEALTH ALLIANCE
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 201 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3401
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Country | US
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Telephone | 662-686-4121
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Fax |
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Provider Business Mailing Address
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Address Line | 201 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3401
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Country | US
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Telephone | 662-686-4121
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | JANE CALHOUN
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Credential |
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Telephone | 662-390-6728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 966642
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License Number State | MS
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