# FAMILY WELLNESS CLINIC LLC

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

## Provider details

- **NPI number:** 1457544066
- **Authorized official:** DR. TANYA S ANDERSON M.D. (MEMBER)
- **Authorized official phone:** (601) 437-5668

## Contact information

- **Practice address:** 703B FARMER ST, PORT GIBSON, MS 39150-2319
- **Practice address phone:** (601) 437-5668
- **Practice address fax:** (601) 437-4533
- **Mailing address:** PO BOX 726, PORT GIBSON, MS 39150-0726
- **Mailing address phone:** (601) 437-5668
- **Mailing address fax:** (601) 437-4533

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 16897 | MS | Yes |

## Other

- **Enumeration date:** 08/27/2007
- **Last updated:** 07/09/2021