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General NPI Number Information
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NPI Number | 1396033379
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Entity Type | Organization
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Legal Business Name | DELTA CLINICS, PLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 9486 HIGHWAY 412 W
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City | LEXINGTON
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State | TN
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Zip | 38351-5713
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Country | US
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Telephone | 731-968-0984
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Fax | 731-668-7388
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Provider Business Mailing Address
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Address Line | 17 CENTRE PLAZA DR
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City | JACKSON
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State | TN
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Zip | 38305-2862
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Country | US
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Telephone | 731-512-0104
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Fax | 731-668-7388
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Authorized Official
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Title or Position | CEO
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Name | DR. SIMON OLALEKAN OKEWOLE
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Credential |
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Telephone | 731-512-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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