Healthcare Provider Details

I. General information

NPI: 1295671139
Provider Name (Legal Business Name): G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 GRAND AVE
YAZOO CITY MS
39194-2949
US

IV. Provider business mailing address

1206 GRAND AVE
YAZOO CITY MS
39194-2949
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLA ELISE PORTER
Title or Position: PHARMACIST
Credential: PHARM D.
Phone: 601-859-5213