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General NPI Number Information
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NPI Number | 1043825110
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Entity Type | Organization
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Legal Business Name | PREMIER FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1493 HIGHWAY 17
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City | CAMDEN
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State | MS
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Zip | 39045-9524
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Country | US
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Telephone | 769-666-9162
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Fax | 877-760-0717
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Provider Business Mailing Address
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Address Line | 109 HIDDEN HOLW
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City | MADISON
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State | MS
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Zip | 39110-4558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAKITA MURRIEL
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Credential | MD
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Telephone | 662-560-3874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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