Organization Name: | GRENADA ADULT HEALTHCARE CLINIC PC. |
NPI Number: | 1144478512 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUSTICE AARON GONDWE (PRESIDENT) |
Mailing Address: | 965 J K Avent Dr Suite 106 Grenada |
State: | MS US |
Postal Code: | 389015045 |
Phone Number: | 6622276450 |
Fax Number: | 6622276452 |
NPI Enumeration Date: | 08/28/2008 |
NPI Last Update Date: | 08/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM2500X |
License Number: | 20373 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Medical Specialty |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |