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General NPI Number Information
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NPI Number | 1972639060
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN MEDICAL CENTER
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 785 OHIO AVE 2D
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City | CLARKSDALE
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State | MS
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Zip | 38614-6217
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Country | US
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Telephone | 662-624-5565
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Fax | 662-624-9971
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Provider Business Mailing Address
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Address Line | 785 OHIO AVE 2D
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City | CLARKSDALE
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State | MS
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Zip | 38614-6217
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Country | US
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Telephone | 662-624-5565
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Fax | 662-624-9971
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. DEBORAH BROOKS
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Credential | MD
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Telephone | 662-624-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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