Grenada Lake Medical Center
NPI #1053684548 in Grenada, Mississippi
Provider Information
- NPI Number
- 1053684548
- Entity Type
- Organization
- Organization Name
- Grenada Lake Medical Center
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- GRENADA LAKE MEDICAL CENTER
- Primary Specialty
- Family Medicine
- Enumeration Date
- Feb 15, 2012
- Last Updated
- Mar 18, 2014
Practice Location
- Address
- 965 AVENT DR STE 100A
- City
- Grenada
- State
- Mississippi
- ZIP Code
- 38901-5045
- Phone
- (662) 227-7444
Authorized Official
- Name
- MR. DAVID G. PUTT, FACHE
- Title
- CEO
- Phone
- (662) 227-7000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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