Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grenada Lake Medical Center

Organization Family Medicine Physician · NPI 1053684548

Grenada Lake Medical Center is a Family Medicine Physician in Grenada, Mississippi. Licensed in Mississippi. Registered with an NPI since 2012.

Licensed in
MS
In the registry since
2012

Practice location Address checks out

965 Avent Dr Ste 100A
Grenada, MS 38901-5045
Phone: (662) 227-7444
Fax: (662) 227-7443
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 21836 (MS)

Record details

NPI number1053684548
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationGrenada Lake Medical Center
Authorized official David Putt — Ceo · (662) 227-7000
Other names Grenada Specialty Clinic - Terry Pummer
NPI enumeratedFebruary 15, 2012
Last updated in NPPESMarch 18, 2014
Mailing address965 Avent Dr Ste 100a, Grenada, MS 38901-5045

Other providers in Grenada