Healthcare Provider Details

I. General information

NPI: 1669804910
Provider Name (Legal Business Name): OAKES FAMILY CARE, LLC DBA THE DOCTOR'S OFFICE: OAKES FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 LISA DRIVE EXT
GREENVILLE MS
38703-4429
US

IV. Provider business mailing address

1907 LISA DRIVE EXT
GREENVILLE MS
38703-4429
US

V. Phone/Fax

Practice location:
  • Phone: 662-335-3252
  • Fax: 662-269-4480
Mailing address:
  • Phone: 662-335-3252
  • Fax: 662-269-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number22238
License Number StateMS

VIII. Authorized Official

Name: LUTHER OAKES
Title or Position: OWNER
Credential: MD
Phone: 662-335-3252