Healthcare Provider Details

I. General information

NPI: 1144548181
Provider Name (Legal Business Name): CARING HANDS FAMILY HEALTH CARE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2010
Last Update Date: 05/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 HIGHWAY 72
BURNSVILLE MS
38833-9320
US

IV. Provider business mailing address

PO BOX 166
BURNSVILLE MS
38833-0166
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-2818
  • Fax:
Mailing address:
  • Phone: 662-665-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR605972
License Number StateMS

VIII. Authorized Official

Name: TAMI BABETTE JOHNSON
Title or Position: ADMINISTRATOR
Credential: FNP
Phone: 662-665-2818