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General NPI Number Information
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NPI Number | 1669510798
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Entity Type | Organization
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Legal Business Name | CALHOUN CITY MEDICAL CLINIC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 120 BURKE - CALHOUN CITY ROAD
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City | CALHOUN CITY
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State | MS
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Zip | 38916
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Country | US
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Telephone | 662-628-5116
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Fax | 662-628-5117
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | CALHOUN CITY
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State | MS
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Zip | 38916-0599
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Country | US
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Telephone | 662-628-5116
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Fax | 662-628-5117
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUY R FARMER SR.
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Credential | MD
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Telephone | 662-628-5116
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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 | 04507
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License Number State | MS
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