# BAZ FAMILY MEDICAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Baz Family Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508353384
- **Authorized official:** JEANETTE SHABAZZ NP (PRESIDEN)
- **Authorized official phone:** (717) 421-5490

## Contact information

- **Practice address:** 4310 CHICOT ST, PASCAGOULA, MS 39581-4700
- **Practice address phone:** (717) 421-5490
- **Mailing address:** 7922 LONGWOOD DR, GAUTIER, MS 39553-2629
- **Mailing address phone:** (717) 421-5490

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R885984 | MS | Yes |

## Other

- **Enumeration date:** 04/17/2018
- **Last updated:** 04/17/2018