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General NPI Number Information
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NPI Number | 1912058231
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Entity Type | Organization
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Legal Business Name | GRENADA FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 418B N APPLEGATE ST
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City | WINONA
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State | MS
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Zip | 38967-1827
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Country | US
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Telephone | 662-283-4433
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Fax | 662-283-4434
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Provider Business Mailing Address
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Address Line | 1300 SUNSET DR STE F
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City | GRENADA
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State | MS
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Zip | 38901-4083
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Country | US
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Telephone | 662-283-4433
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Fax | 662-283-4434
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH C ARMSTRONG JR.
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Credential | M.D.
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Telephone | 662-226-5747
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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 |
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License Number State |
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