Healthcare Provider Details

I. General information

NPI: 1568581213
Provider Name (Legal Business Name): FAMILY FIRST MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25073 HIGHWAY 1 S.
PLAQUEMINE LA
70764
US

IV. Provider business mailing address

25073 HIGHWAY 1 S.
PLAQUEMINE LA
70764
US

V. Phone/Fax

Practice location:
  • Phone: 225-687-1772
  • Fax: 225-687-1013
Mailing address:
  • Phone: 225-687-1772
  • Fax: 225-687-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONIO EDWARDS
Title or Position: OWNER
Credential: M.D.
Phone: 225-687-1772