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General NPI Number Information
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NPI Number | 1740798503
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Entity Type | Organization
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Legal Business Name | CLD MEDICAL ENTERPRISES PLLC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 212 DRAPERTON CT STE A
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City | RIDGELAND
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State | MS
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Zip | 39157-3905
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Country | US
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Telephone | 601-936-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 671 MUIRWOOD CIR
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City | RIDGELAND
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State | MS
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Zip | 39157-3631
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Country | US
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Telephone | 601-953-2410
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Fax | 601-936-0088
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTINA L DIAL
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Credential | DO
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Telephone | 601-953-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18187
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 18187
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License Number State | MS
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