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General NPI Number Information
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NPI Number | 1831656354
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Entity Type | Organization
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Legal Business Name | BOUNDS FAMILY MEDICAL
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 821 MAIN ST
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City | FAYETTE
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State | MS
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Zip | 39069-5695
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Country | US
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Telephone | 601-809-0882
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Fax | 601-809-0883
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | FAYETTE
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State | MS
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Zip | 39069-0091
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Country | US
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Telephone | 601-809-0882
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | LISA HALFORD
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Credential |
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Telephone | 601-807-9550
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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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