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General NPI Number Information
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NPI Number | 1215193933
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Entity Type | Organization
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Legal Business Name | THE CLINIC AT ELM LAKE, P.A.
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 3700 N FRONTAGE RD
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City | COLUMBUS
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State | MS
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Zip | 39701
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Country | US
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Telephone | 662-240-9999
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Fax | 662-241-5451
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Provider Business Mailing Address
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Address Line | 3700 N FRONTAGE RD
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City | COLUMBUS
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State | MS
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Zip | 39701
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Country | US
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Telephone | 662-240-9999
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Fax | 662-241-5451
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. ANNMARIE STOKES
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Credential | M.D.
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Telephone | 662-240-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MS13926
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License Number State | MS
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