Chickasaw FMC
Organization Active NPI Family Medicine Physician · Okolona, MS
NPI 1710101902 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1710101902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CHICKASAW FMC
- Practice address
- 518 West Dr
Okolona, MS 38860-1624 - Phone
- (662) 447-2255
- NPI assigned
- Apr 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Chris Dedeaux
- Title
- Clinic Administrator
- Phone
- (622) 256-7112
Corporate family (same tax ID) 16
National Provider Directory
- Tax ID family
- Gilmore Primary Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
518 West Dr
Okolona, MS 38860-1624
Mailing address
123 Main St N
Amory, MS 38821-3416
Other providers in Okolona, MS
- Access Family Health Services, Inc.
- Stephenie Brady
- Michael Bullock
- Sarah Carollo
- Joy S Chapman
- Family Medical Clinic of Okolona
- Shatessie Marie Ford
- Harley'S Home Care
- Heavenly Angels Community Living, Inc.
- Whitley Breanna Hill
All providers in Okolona, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.