| NPI | 1063639185 |
|---|---|
| Former Legal Business Name | NORTHEAST MISSISSIPPI DERMATOLOGY CENTER, PC |
| Entity Type | Organization |
| Authorized Contact | CHARLES M. WREN President 662-891-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 14798) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-01-17 |