# MEDICAL SOUTH FAMILY PRACTICE ASSOC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medical South Family Practice Assoc Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659388320
- **Authorized official:** DR. AMY WOOTON M.D. (PRESIDENT)
- **Authorized official phone:** (937) 433-0960

## Contact information

- **Practice address:** 330 N MAIN ST, SUITES \#101-102, CENTERVILLE, OH 45459-4465
- **Practice address phone:** (937) 433-0960
- **Practice address fax:** (937) 433-0958
- **Mailing address:** 330 N MAIN ST, SUITES \#101-102, CENTERVILLE, OH 45459-4465
- **Mailing address phone:** (937) 433-0960
- **Mailing address fax:** (937) 433-0958

## Taxonomy

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

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 05/18/2010