| NPI | 1093499907 |
|---|---|
| Doing Business As | MISSISSIPPI MEDICAL CLINIC MENDENHALL |
| Entity Type | Organization |
| Authorized Contact | CHANTE N FERGUSON Owner 601-675-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-02-16 |