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Organization

DESOTO FAMILY MEDICAL PRACTICE, P.C.

Active
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Organization

DESOTO FAMILY MEDICAL PRACTICE, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KAREN M TATE (SECRETARY)
(662) 895-3700
Entity
Organization

Contact information

Practice address
7163 GOODMAN RD, OLIVE BRANCH, MS 38654-1904
(662) 895-3700
(662) 895-4886
Mailing address
7163 GOODMAN RD, P. O. BOX 518, OLIVE BRANCH, MS 38654-1904
(662) 895-3700
(662) 895-4886

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—

Other

Enumeration date
08/12/2006
Last updated
11/19/2011
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