Family Wellness Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16897 Issued in MS

Legal business name

FAMILY WELLNESS CLINIC LLC

Practice address

703B Farmer St
Port Gibson, MS 39150-2319

Phone

(601) 437-5668

Fax

(601) 437-4533

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tanya S Anderson, M.D.NPI 1487708525

Title

Member

Phone

(601) 437-5668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanya Savage Anderson, M.D.

  • Family Medicine Physician
  • Port Gibson, MS
  • NPI 1487708525
  Medicare reassignment NPD Authorized official
• Danny Ellis, NP

  • Nurse Practitioner
  • Vicksburg, MS
  • NPI 1760699540
  NPD (past)

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1457544066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 726",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391500726",
            "telephone_number": "601-437-5668",
            "fax_number": "601-437-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703B FARMER ST",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391502319",
            "telephone_number": "601-437-5668",
            "fax_number": "601-437-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-437-5668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122761",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dan Ellis GNP Inc
• David M. Headley, M.D. PA
• Delta Therapy Solutions, LLC
• Eli George Ellis Jr., DDS
• Edith Ifeyinwa Ezekwe, RDN, ASCP,
• Summer Hayes Fife, MOTR/L
• Linda B Fouche
• Shaunda T Freeman, FNP
• Ftfrx LLC
• Go Therapy LLC

• Family Medicine Physician in Port Gibson, MS
• Providers in Port Gibson, 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 Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.