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General NPI Number Information
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NPI Number | 1821033341
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 218 S VICTORIA AVE
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City | CLEVELAND
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State | MS
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Zip | 38732-3234
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Country | US
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Telephone | 901-217-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 218 S VICTORIA AVE
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City | CLEVELAND
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State | MS
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Zip | 38732-3234
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Country | US
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Telephone | 901-217-3480
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DEBORAH MICHELLE BROOKS
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Credential | M.D.
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Telephone | 901-217-3480
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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 | 17310
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License Number State | MS
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