=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043189335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY 1ST FAMILY CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 MAIN ST STE A
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-6197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-641-4070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 MAIN ST STE A
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-6197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | REGINA LEE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 601-641-4070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------