OrganizationActive
Grenada Adult Healthcare Clinic PC.
NPI 1144478512 · Primary Care Clinic/Center · Grenada, MS
Provider details
- NPI number
- 1144478512
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Justice Gondwe, President(662) 227-6450
- License
- 20373 (MS)
Specialties & taxonomies
Ambulatory Health Care Facilities
Ambulatory Health Care Facilities
Practice location
965 J K Avent Dr
Suite 106
Grenada, MS 38901-5045
Phone: (662) 227-6450
Fax: (662) 227-6452
Approximate (ZIP-level) locationGet directions
Mailing address
965 J K Avent Dr
Grenada, MS 38901-5045
Other names (DBA / former)
- Doing business as
- Grenada Adult Healthcare Clinic PC.
Registry dates
- Enumerated
- 2008-08-28
- Last updated
- 2008-08-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.