Vicksburg Special Care Clinic LLC
NPI #1487988002 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1487988002
- Entity Type
- Organization
- Organization Name
- Vicksburg Special Care Clinic LLC
- Primary Specialty
- Family Medicine
- Enumeration Date
- Sep 29, 2009
- Last Updated
- Oct 29, 2014
Practice Location
- Address
- 4077 PEMBERTON SQUARE BLVD
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39180-5580
- Phone
- (601) 638-8600
Authorized Official
- Name
- MITCHELL CHAD BARRETT
- Title
- OWNER/MEMBER
- Phone
- (601) 529-9341
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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