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NPI 1134302136

OrganizationActive

Grenada Lake Medical Center

NPI 1134302136 · Clinic/Center · Grenada, MS

Provider details

NPI number: 1134302136
Entity type: Organization
Primary specialty: Clinic/CenterAmbulatory Health Care Facilities
Authorized official: Charles Denton, Ceo
License: 11-245 (MS)

Practice location

965 Avent Dr Ste 105

Grenada, MS 38901-5045

Phone: (662) 227-7575

More MS providers

Mailing address

965 Avent Dr Ste 105

Grenada, MS 38901-5045

Registry dates

Enumerated: 2007-12-12
Last updated: 2007-12-17

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Grenada Lake Medical Center — NPI 1134302136, Grenada, MS | NPI Central