Healthcare Provider Details

I. General information

NPI: 1154533677
Provider Name (Legal Business Name): SOUTHERN FAMILY HEALTHCARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 3RD ST STE 4
CHIPLEY FL
32428-1855
US

IV. Provider business mailing address

877 3RD ST STE 4
CHIPLEY FL
32428-1855
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-4383
  • Fax: 850-415-6783
Mailing address:
  • Phone: 850-638-4383
  • Fax: 850-415-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MARK GARNEY
Title or Position: PRESIDENT
Credential: ARNPC
Phone: 850-638-5512