Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
May 4, 2006
License(s)
14136 (MS), 036-086635 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 3211 SHANNON RD SUITE 300 | Durham, NC 27707-6322 | 800-291-4020 |
| LOCATION | 100 HOSPITAL ST | Booneville, MS 38829-3354 | 800-291-4020 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.