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General NPI Number Information
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NPI Number | 1811660293
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Entity Type | Organization
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Legal Business Name | MCFATTER FAMILY MEDICAL, LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 710 HIGHLAND COLONY PKWY STE A
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City | RIDGELAND
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State | MS
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Zip | 39157-8701
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Country | US
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Telephone | 601-398-9886
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Fax | 601-398-9885
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Provider Business Mailing Address
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Address Line | 305 COVINGTON CV
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City | MADISON
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State | MS
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Zip | 39110-4581
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Country | US
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Telephone | 601-398-9886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL HURLEY MCFATTER
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Credential |
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Telephone | 601-398-9886
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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