Healthcare Provider Details

I. General information

NPI: 1275443350
Provider Name (Legal Business Name): G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 HIGHWAY 82 W
ITTA BENA MS
38941-1400
US

IV. Provider business mailing address

1668 W PEACE ST
CANTON MS
39046-5332
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-5213
  • Fax:
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: JAMES COLEMAN
Title or Position: CEO
Credential:
Phone: 601-859-5213