# FAMILY PRACTICE CLINIC OF WATER VALLEY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255414173
- **Authorized official:** DRAGICA MILICEVIC MD (FAMILY PRACTICE)
- **Authorized official phone:** (662) 473-4050

## Contact information

- **Practice address:** 606 SO MAIN ST, WATER VALLEY, MS 38965
- **Practice address phone:** (662) 473-4050
- **Practice address fax:** (662) 473-4191
- **Mailing address:** PO BOX 643, WATER VALLEY, MS 38965
- **Mailing address phone:** (662) 473-4050
- **Mailing address fax:** (662) 473-4191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 18660 | MS | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/12/2008