# OLIVE BRANCH FAMILY MEDICAL CENTER

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

## Provider details

- **NPI number:** 1629018478
- **Authorized official:** AMY GREEN (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (662) 893-8484

## Contact information

- **Practice address:** 9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
- **Practice address phone:** (662) 895-4949
- **Practice address fax:** (662) 895-6776
- **Mailing address:** 9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
- **Mailing address phone:** (662) 895-4949
- **Mailing address fax:** (662) 895-6776

## Taxonomy

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

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 12/21/2020