Grenada Lake Medical Center

NPI #1922187095 in Grenada, Mississippi

Provider Information

NPI Number: 1922187095
Entity Type: Organization
Organization Name: Grenada Lake Medical Center
Primary Specialty: Orthopaedic Surgery
Enumeration Date: Nov 2, 2006
Last Updated: Mar 4, 2011

Practice Location

Address: 960 J K AVENT DR
City: Grenada
State: Mississippi
ZIP Code: 38901-5230
Phone: (662) 227-7000

Authorized Official

Name: MR. CHARLES L DENTON
Title: CEO
Phone: (662) 227-7000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Orthopaedic Surgery	207X00000X	Primary

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