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General NPI Number Information
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NPI Number | 1326149956
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Entity Type | Organization
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Legal Business Name | THE NEUROSURGICAL CENTER
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 55 PHYSICIANS LN SUITE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9569
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Country | US
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Telephone | 662-349-5660
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Fax | 662-349-5669
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Provider Business Mailing Address
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Address Line | 55 PHYSICIANS LN SUITE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9569
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Country | US
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Telephone | 662-349-5660
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Fax | 662-349-5669
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Authorized Official
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Title or Position | OWNER
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Name | WINSTON CRAIG CLARK
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Credential | M.D.
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Telephone | 662-349-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD14839
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License Number State | TN
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