Organization · Type 2 NPI

Grenada Lake Medical Center

Family Medicine Physician · Grenada, MS

NPI number 1053684548 Active

Practice location

965 Avent Dr Ste 100A
Grenada, MS 38901-5045

Fax (662) 227-7443

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	21836 (MS)

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Other family medicine physician providers in Grenada

See all in Grenada →

NPI record

NPI: 1053684548
Entity type: Organization (Type 2)
Issued: Feb 15, 2012
Last updated: Mar 18, 2014
Status: Active
Subpart: Yes of Grenada Lake Medical Center

Other names

<unavail>
Grenada Specialty Clinic - Terry Pummer · doing business as

Authorized official

Mr. David G. Putt, FACHE
CEO
(662) 227-7000

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1053684548

Grenada Lake Medical Center's National Provider Identifier is 1053684548, issued on Feb 15, 2012. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Grenada, MS. The record was last updated on Mar 18, 2014.