Healthcare Provider Details

I. General information

NPI: 1154418655
Provider Name (Legal Business Name): FIRST FAMILY HEALTHCARE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SOUTH OAK STREET STE 2
RAYMOND MS
39154
US

IV. Provider business mailing address

PO BOX 1186
RAYMOND MS
39154-1186
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-2300
  • Fax: 601-709-2305
Mailing address:
  • Phone: 601-709-2300
  • Fax: 601-709-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SALOUM CISSE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 601-709-2300