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General NPI Number Information
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NPI Number | 1982902458
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CLINIC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 102 JULIA STREET
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City | ISOLA
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State | MS
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Zip | 38754
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Country | US
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Telephone | 662-962-7923
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Fax | 662-962-2575
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Provider Business Mailing Address
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Address Line | P.O. BOX 553
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City | ISOLA
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State | MS
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Zip | 38754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BOBBIE G MILLER
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Credential |
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Telephone | 601-962-2576
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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 | MS
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