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Organization
FAMILY WELLNESS CLINIC LLC
Active
Organization
FAMILY WELLNESS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANYA S ANDERSON M.D. (MEMBER)
(601) 437-5668
Entity
Organization
Contact information
Practice address
703B FARMER ST, PORT GIBSON, MS 39150-2319
(601) 437-5668
(601) 437-4533
Mailing address
PO BOX 726, PORT GIBSON, MS 39150-0726
(601) 437-5668
(601) 437-4533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16897
MS
Other
Enumeration date
08/27/2007
Last updated
07/09/2021
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