| NPI | 1942554761 |
|---|---|
| Doing Business As | ELLISVILLE MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | JAMES T CANIZARO C.F.O. / Vice President 601-399-6139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2012-10-31 |