Healthcare Provider Details

I. General information

NPI: 1013569847
Provider Name (Legal Business Name): G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 W PEACE ST
CANTON MS
39046-5332
US

IV. Provider business mailing address

PO BOX 588
CANTON MS
39046-0588
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-5213
  • 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: JOSEPH DAVIS
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 601-859-5213