MEDICARE: GREENVILLE FAMILY MEDICAL CENTER INC

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	261QR1300X	Rural Health Clinic/Center
2	305R00000X	Preferred Provider Organization		MS

General Provider Information

NPI Number	:	1932197779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE FAMILY MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1467 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-7141
Country	:	US
Telephone Number	:	662-335-1621
Fax Number	:	662-335-8128

Provider Business Practice Location Address
First Line	:	1467 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-7141
Country	:	US
Telephone Number	:	662-335-1621
Fax Number	:	662-335-8128

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. JOE S PULLIAM
Credential	:	M. D.
Telephone Number	:	662-335-1621

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/27/2025

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