Southern Family Medicine
Clinic/Center, Medical Specialty in Collins, MS. Organization (NPI-2).
NPI number1982608691
StatusActive
Last updated in NPPESJan 22, 2019
Details
- NPI
- 1982608691
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Family Medicine
- Organization subpart
- No
- Enumeration date
- Jun 9, 2005
- Last updated
- Jan 22, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2500X | Clinic/Center, Medical Specialty | – | – | Yes |
Practice location
603 S Holly AveCollins, MS 39428-3801
Phone 601-765-9393 · Fax 601-765-9363
Mailing address
606 Gerald McRaney StCollins, MS 39428-3801
Phone 601-765-9393 · Fax 601-765-9363
Authorized official
Jason Gregory Beasley
Owner
6017659393
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