Healthcare Provider Details

I. General information

NPI: 1255498044
Provider Name (Legal Business Name): G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 W PEACE ST
CANTON MS
39046
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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

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