# CALEDONIA COMMUNITY CLINIC, LLC

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

## Provider details

- **NPI number:** 1619552130
- **Authorized official:** MS. LISA JORDAN HUDSON NP (FNP-C)
- **Authorized official phone:** (662) 251-3451

## Contact information

- **Practice address:** 171 SOUTH ST, CALEDONIA, MS 39740-8587
- **Practice address phone:** (662) 855-0080
- **Mailing address:** PO BOX 217, CALEDONIA, MS 39740-0217
- **Mailing address phone:** (662) 251-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2021
- **Last updated:** 03/16/2021