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General NPI Number Information
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NPI Number | 1093284366
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Entity Type | Organization
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Legal Business Name | HICKORY FAMILY MEDICAL CLINIC INC
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 18199 HIGHWAY 80
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City | HICKORY
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State | MS
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Zip | 39332-3452
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Country | US
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Telephone | 601-646-5445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | HICKORY
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State | MS
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Zip | 39332-0220
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Country | US
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Telephone | 601-646-5445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA MORGAN
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Credential | MD
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Telephone | 601-954-8096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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