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General NPI Number Information
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NPI Number | 1891563334
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Entity Type | Organization
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Legal Business Name | LAUREL CANCER CARE, LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 127 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4111
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Country | US
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Telephone | 601-425-2999
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Fax | 601-425-3286
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Provider Business Mailing Address
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Address Line | 127 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4111
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Country | US
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Telephone | 601-425-2999
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Fax | 601-425-3286
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Authorized Official
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Title or Position | ADMINISTRATIVE LEADER
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Name | LADONNA BRELAND
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Credential |
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Telephone | 601-425-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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