=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508273335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH CENTRAL CLINICS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2014
-----------------------------------------------------
Last Update Date | 04/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 JEFFERSON ST SUITE 300
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39440-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-649-1013
-----------------------------------------------------
Fax | 601-426-5102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 247
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39441-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-425-7550
-----------------------------------------------------
Fax | 601-399-6281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CLINIC SUPPORT
-----------------------------------------------------
Name | MONICA MORROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-399-6167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------