Healthcare Provider Details

I. General information

NPI: 1669510798
Provider Name (Legal Business Name): CALHOUN CITY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BURKE - CALHOUN CITY ROAD
CALHOUN CITY MS
38916
US

IV. Provider business mailing address

PO BOX 599
CALHOUN CITY MS
38916-0599
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-5116
  • Fax: 662-628-5117
Mailing address:
  • Phone: 662-628-5116
  • Fax: 662-628-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04507
License Number StateMS

VIII. Authorized Official

Name: DR. GUY R FARMER SR.
Title or Position: OWNER
Credential: MD
Phone: 662-628-5116