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General NPI Number Information
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NPI Number | 1801471172
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHARM FAMILY HEALTHCARE
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 1201 HIGHWAY 49 S STE 46
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City | RICHLAND
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State | MS
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Zip | 39218-9438
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Country | US
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Telephone | 601-829-6151
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Fax | 769-241-0044
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Provider Business Mailing Address
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Address Line | 515 BELLE OAK PL
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City | BRANDON
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State | MS
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Zip | 39042-8111
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Country | US
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Telephone | 601-829-6151
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Fax | 769-241-0044
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Authorized Official
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Title or Position | OWNER
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Name | KELLI MARIE FOSTER
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Credential | NP-C
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Telephone | 601-829-6151
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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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