MEDICARE: ALLGOOD FAMILY MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11525	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC9959	OTHER	MS	RAILROAD MEDICARE GROUP

General Provider Information

NPI Number	:	1184736654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLGOOD FAMILY MEDICAL PC

Provider Business Mailing Address
First Line	:	9930 SARACENNIA RD
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-7874
Country	:	US
Telephone Number	:	228-475-7877
Fax Number	:	228-475-8085

Provider Business Practice Location Address
First Line	:	9930 SARACENNIA RD
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-7874
Country	:	US
Telephone Number	:	228-475-7877
Fax Number	:	228-475-8085

Authorized Official
Title or Position	:	VICE PRESIDENT OF CORP
Name	:	MRS. DENISE JEAN ALLGOOD
Credential	:
Telephone Number	:	228-475-7877

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “ALLGOOD FAMILY MEDICAL PC ” Practice Location

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