GOLDEN AGE INC NPI 1558693671

NPI Information

NPI: 1558693671
Provider Name: GOLDEN AGE INC
Classification: Clinic/Center - 261QR1300X
Specialization: Rural Health
Entity Type: Organization
Doing Business As: GOLDEN AGE CLINIC
CLIA Number: 25D2003324
Address: 2901 HIGHWAY 82 E
GREENWOOD, MS
ZIP 38930
Phone: (662) 374-2185

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NPI Details

GOLDEN AGE INC is a rural health clinic center in Greenwood, MS. GOLDEN AGE INC NPI is 1558693671. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Golden Age Clinic.

The provider's business location address is:

2901 HIGHWAY 82 E
GREENWOOD, MS
ZIP 38930-960
Phone: (662) 374-2185
Fax: (662) 374-2195

The provider's authorized official is Tabatha Danielle Watkins .
The authorized official title is Administrator and has the following contact phone number (662) 453-6323.

The CLIA number assigned to this NPI record is 25D2003324 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/1/2010 and was last updated on 1/6/2022.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	261QR1300X	Clinic/Center	Rural Health		MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	09705072	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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