| Organization Name: | MISSISSIPPI MEDICAL RESEARCH, LLC |
| NPI Number: | 1326312786 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AHMAD HAIDAR (OWNER) |
| Mailing Address: | 1016 Sixth Ave Ste B Picayune |
| State: | MS US |
| Postal Code: | 394663861 |
| Phone Number: | 6017493549 |
| Fax Number: | 6017493448 |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 03/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1100X |
| License Number: | 13678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Research |
| Taxonomy Definition: | |