Family Practice Clinic of Water Valley

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

18660 Issued in MS

Legal business name

FAMILY PRACTICE CLINIC OF WATER VALLEY

Practice address

606 So Main St
Water Valley, MS 38965

Phone

(662) 473-4050

Fax

(662) 473-4191

NPI assigned

Oct 23, 2006

Last updated

Aug 12, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dragica Milicevic, MD

Title

Family Practice

Phone

(662) 473-4050

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1255414173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 643",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "38965",
            "telephone_number": "662-473-4050",
            "fax_number": "662-473-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 SO MAIN ST",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "38965",
            "telephone_number": "662-473-4050",
            "fax_number": "662-473-4191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE CLINIC OF WATER VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "MILICEVIC",
        "authorized_official_first_name": "DRAGICA",
        "authorized_official_title_or_position": "FAMILY PRACTICE",
        "authorized_official_telephone_number": "662-473-4050",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "18660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01265531",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Watkins Edwards, OD
• Evernorth Direct Health LLC
• Evernorth Direct Health LLC
• Family Health Care Clinic, Inc.
• Family Practice Clinic of Water Valley
• Taylor Robertson Faulkner, DPT
• Cody Elizabeth Field, FNP-C
• Jessica Fortner, OTR/L
• Cinnamon Caryl Foster, MSN, FNP-BC
• Angela Furlong, RRT

• Family Medicine Physician in Water Valley, MS
• Providers in Water Valley, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.