Healthcare Provider Details

I. General information

NPI: 1831608686
Provider Name (Legal Business Name): COMPLETE FAMILY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHWAY 51 N STE A
BROOKHAVEN MS
39601-2653
US

IV. Provider business mailing address

201 HIGHWAY 51 N STE A
BROOKHAVEN MS
39601-2653
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-5333
  • Fax:
Mailing address:
  • Phone: 601-833-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902069
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR871958
License Number StateMS

VIII. Authorized Official

Name: BRITTANY NICOLE GRIFFIN
Title or Position: PARTNER/ OWNER
Credential: NP
Phone: 601-748-6238