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General NPI Number Information
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NPI Number | 1659041663
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Entity Type | Organization
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Legal Business Name | CARE CLINIC FOR DRUG ADDICTION & MENTAL HEALTH IN NORTH MISSISSIPPI
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 8829 CENTRE ST STE 200
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City | SOUTHAVEN
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State | MS
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Zip | 38671-2610
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Country | US
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Telephone | 662-934-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 222 SOUTHLAKES DR
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City | GRENADA
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State | MS
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Zip | 38901-8499
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Country | US
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Telephone | 662-934-8671
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CEDRIC EDWARDS
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Credential | M.D.
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Telephone | 662-934-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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