Healthcare Provider Details

I. General information

NPI: 1669010732
Provider Name (Legal Business Name): G A CARMICHAEL FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 W PEACE ST
CANTON MS
39046-5332
US

IV. Provider business mailing address

1668 W PEACE ST
CANTON MS
39046-5332
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-0273
  • Fax:
Mailing address:
  • Phone: 601-859-0273
  • Fax: 601-859-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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