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General NPI Number Information
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NPI Number | 1750447926
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Entity Type | Organization
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Legal Business Name | EAST METRO FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 811 HIGHWAY 49 S
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City | RICHLAND
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State | MS
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Zip | 39218-9408
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Country | US
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Telephone | 601-932-5060
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Fax | 601-932-5062
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Provider Business Mailing Address
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Address Line | 811 HIGHWAY 49 S
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City | RICHLAND
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State | MS
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Zip | 39218-9408
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Country | US
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Telephone | 601-932-5060
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Fax | 601-932-5062
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Authorized Official
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Title or Position | OWNER
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Name | DR. DON A. GIBSON
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Credential | M.D.
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Telephone | 601-932-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | 07980
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License Number State | MS
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