Healthcare Provider Details

I. General information

NPI: 1235295304
Provider Name (Legal Business Name): G A CARMICHAEL FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E FIRST ST
BELZONI MS
39038
US

IV. Provider business mailing address

PO BOX 588
CANTON MS
39046-0588
US

V. Phone/Fax

Practice location:
  • Phone: 622-247-1252
  • Fax: 601-859-8771
Mailing address:
  • Phone: 601-859-5213
  • Fax: 601-859-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES L. COLEMAN JR.
Title or Position: CEO
Credential: ED.D
Phone: 601-859-5213