Provider Demographics
NPI:1598908774
Name:L.C. TENNIN, JR M.D., P.A.
Entity Type:Organization
Organization Name:L.C. TENNIN, JR M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LC
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-214-5998
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4502
Practice Address - Country:US
Practice Address - Phone:601-859-8992
Practice Address - Fax:601-859-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty