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

Grenada Lake Medical Center

Organization Clinic/Center · NPI 1134302136

Grenada Lake Medical Center is a Clinic/Center in Grenada, Mississippi. Licensed in Mississippi. Registered with an NPI since 2007.

Licensed in
MS
In the registry since
2007
Specialties on file
2

Practice location Address checks out

965 Avent Dr Ste 105
Grenada, MS 38901-5045
Phone: (662) 227-7575
Show map & directions

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

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X · Licence 11-245 (MS)
General Acute Care Hospital Taxonomy 282N00000X · Licence 11-245 (MS)

Record details

NPI number1134302136
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Charles Denton — Ceo · (662) 227-7000
Other names Grenada Primary Care Clinic
NPI enumeratedDecember 12, 2007
Last updated in NPPESDecember 17, 2007
Mailing address965 Avent Dr Ste 105, Grenada, MS 38901-5045

Other providers in Grenada