LIVE OAKS ADDICTION PROFESSIONALS NPI 1619433943

NPI Information

LIVE OAKS ADDICTION PROFESSIONALS is an addiction medicine family medicine in Southaven, MS. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. LIVE OAKS ADDICTION PROFESSIONALS NPI is 1619433943. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5699 GETWELL RD STE 1
SOUTHAVEN, MS
ZIP 38672-312
Phone: (662) 510-8400
Fax: (662) 510-8500

The provider's authorized official is Gary D. Carr .
The authorized official title is Sole Member and has the following contact phone number (662) 510-8400.

The CLIA number assigned to this NPI record is 25D2190931 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/12/2019 and was last updated on 2/12/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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