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General NPI Number Information
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NPI Number | 1871098350
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Entity Type | Organization
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Legal Business Name | BYRD FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 705 N STATE ST
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City | CLARKSDALE
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State | MS
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Zip | 38614
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Country | US
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Telephone | 662-627-2973
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Fax | 662-624-5595
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Provider Business Mailing Address
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Address Line | 764 WALNUT KNOLL LN
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City | CORDOVA
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State | TN
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Zip | 38018-3113
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Country | US
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Telephone | 901-620-6397
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Fax | 901-756-5564
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Authorized Official
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Title or Position | OWNER
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Name | MS. LEA ANN BYRD
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Credential | FNP
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Telephone | 662-627-2973
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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 | R823849
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License Number State | MS
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