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General NPI Number Information
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NPI Number | 1679061469
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Entity Type | Organization
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Legal Business Name | NUVENA VEIN CLINIC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 120 FOUNTAINS BLVD
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-667-4405
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Fax | 601-667-4406
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Provider Business Mailing Address
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Address Line | 107 ROSEDOWNE BEND
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLIFFORD C ADAMS III
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Credential | MD
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Telephone | 601-506-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 13236
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License Number State | MS
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