Provider Demographics
NPI:1811265622
Name:EAST MISSISSIPPI MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:EAST MISSISSIPPI MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZEE
Authorized Official - Middle Name:AMEIR
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-635-3333
Mailing Address - Street 1:9425 EASTSIDE DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-8068
Mailing Address - Country:US
Mailing Address - Phone:601-635-3333
Mailing Address - Fax:601-635-3330
Practice Address - Street 1:9425 EASTSIDE DRIVE EXT
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8068
Practice Address - Country:US
Practice Address - Phone:601-635-3333
Practice Address - Fax:601-635-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty