Healthcare Provider Details

I. General information

NPI: 1578744900
Provider Name (Legal Business Name): FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BROAD STREET
SANDERSVILLE MS
39477-0279
US

IV. Provider business mailing address

P.O. BOX 4361
LAUREL MS
39441-4361
US

V. Phone/Fax

Practice location:
  • Phone: 601-428-9918
  • Fax: 601-649-5575
Mailing address:
  • Phone: 601-425-3033
  • Fax: 601-422-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. RASHAD N. ALI
Title or Position: EXECUTIVE DIRECTOR
Credential: MD, JD, FACOG
Phone: 601-425-3033