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General NPI Number Information
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NPI Number | 1124481791
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Entity Type | Organization
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Legal Business Name | FAMILY CARE CLINIC, PLLC
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 1440 HIGHWAY 1 S
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City | GREENVILLE
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State | MS
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Zip | 38701-7140
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Country | US
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Telephone | 662-820-7780
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Fax | 888-980-6547
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Provider Business Mailing Address
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Address Line | PO BOX 3946
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City | GREENVILLE
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State | MS
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Zip | 38704-3946
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Country | US
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Telephone | 662-820-7780
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Fax | 888-980-6547
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LAMONICA ANTONETTE HODGES
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Credential | NP
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Telephone | 662-820-7780
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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 | 901388
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License Number State | MS
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