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General NPI Number Information
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NPI Number | 1730903113
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Entity Type | Organization
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Legal Business Name | SOUTHERN SPECIALTY CLINIC, LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 803 LIBERTY RD
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City | FLOWOOD
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State | MS
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Zip | 39232-9000
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Country | US
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Telephone | 601-714-1967
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Fax | 601-714-1966
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Provider Business Mailing Address
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Address Line | 122 WOODLANDS GLEN CIR
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City | BRANDON
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State | MS
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Zip | 39047-7107
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Country | US
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Telephone | 601-985-8296
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. SHARON MARIE PENNINGTON
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Credential | MD
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Telephone | 601-985-8296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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