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General NPI Number Information
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NPI Number | 1477890911
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Entity Type | Organization
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Legal Business Name | DELTA HEALTH CENTER, INC
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 702 MARTIN LUTHER KING ST
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City | MOUND BAYOU
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State | MS
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Zip | 38762-9314
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Country | US
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Telephone | 662-741-8882
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Fax | 662-741-8871
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Provider Business Mailing Address
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Address Line | 702 MARTIN LUTHER KING ST
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City | MOUND BAYOU
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State | MS
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Zip | 38762-9314
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Country | US
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Telephone | 662-741-8882
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Fax | 662-741-8871
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Authorized Official
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Title or Position | PROVIDER
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Name | GREGORY NORWOOD
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Credential | MD
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Telephone | 662-741-8871
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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 |
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License Number State | MS
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