| NPI | 1154670719 |
|---|---|
| Doing Business As | LACKEY PEDIATRIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOHN P LEE Chairman Of The Board 601-849-6440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MS 13-033) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-05-26 |