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General NPI Number Information
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NPI Number | 1558713511
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Entity Type | Organization
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Legal Business Name | CALHOUN MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 5135 HWY 84W
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City | LAUREL
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State | MS
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Zip | 39443
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Country | US
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Telephone | 601-340-3544
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Fax | 601-651-2926
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Provider Business Mailing Address
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Address Line | 5135 HWY 84W
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City | LAUREL
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State | MS
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Zip | 39443
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Country | US
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Telephone | 601-340-3544
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Fax | 601-651-2926
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Authorized Official
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Title or Position | CFO
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Name | MRS. CHARLOTTE F DELOACH
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Credential |
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Telephone | 601-433-2998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14545
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License Number State | MS
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