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General NPI Number Information
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NPI Number | 1417481474
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Entity Type | Organization
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Legal Business Name | THE DOWNTOWN FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 345 WASHINGTON AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-3615
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Country | US
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Telephone | 662-347-6686
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Fax |
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Provider Business Mailing Address
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Address Line | 1462 S COLORADO ST APT 5A
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City | GREENVILLE
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State | MS
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Zip | 38703-7263
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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 | PRESIDENT
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Name | ALEXIS CROSS
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Credential | CFNP
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Telephone | 662-347-6686
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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 | 901361
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License Number State | MS
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