Nettleton Family Medical Clinic, Inc.
Organization Active NPI Primary Care Clinic/Center · Nettleton, MS
NPI 1003005125 · NPPES record last updated Nov 13, 2012
Key facts
- NPI
- 1003005125
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- R850606 (MS)
- Legal business name
- NETTLETON FAMILY MEDICAL CLINIC, INC.
- Practice address
- 1495 Maple Rd
Nettleton, MS 38858-6026 - Phone
- (662) 963-9146
- Fax
- (662) 963-9186
- NPI assigned
- Oct 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Andrew Curry Justice, CFNP
- Title
- Owner
- Phone
- (662) 963-9146
National Provider Directory
Locations
1495 Maple Rd
Nettleton, MS 38858
Phone (662) 963-9146
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | R682403 | MS | |
| Primary Care Clinic/Center | 261QP2300X | R850606 | MS | Yes |
Addresses
Primary practice location
1495 Maple Rd
Nettleton, MS 38858-6026
Mailing address
1495 Maple Rd
Nettleton, Ms, MS 38858-6026
Phone (662) 963-9146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00328681 | Medicaid | MS |
Other providers in Nettleton, MS
- Garry M McFerrin
- Meredith Moore
- Sally Lawson Morgan
- Nettleton Dental LLC
- Nettleton Family Clinic
- Nettleton Medical Express Care LLC
- Kimberly Ray
- Deborra Cassandra Rikard
- Cynthia J Rushing
- Saving Grace Respite Center
All providers in Nettleton, MS · Primary Care Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.