The Mane Physician
NPI #1902435118 in Grenada, Mississippi
Provider Information
- NPI Number
- 1902435118
- Entity Type
- Organization
- Organization Name
- The Mane Physician
- Primary Specialty
- Prosthetic/Orthotic Supplier
- Enumeration Date
- Apr 8, 2020
- Last Updated
- Apr 8, 2020
Practice Location
- Address
- 94 SPAIN DRIVE
- City
- Grenada
- State
- Mississippi
- ZIP Code
- 38901
- Phone
- (769) 487-4787
Authorized Official
- Name
- MRS. CAMALA CHISM
- Title
- OWNER
- Phone
- (769) 487-4187
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetic/Orthotic Supplier |
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