# CHICKASAW FMC

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

## Provider details

- **NPI number:** 1710101902
- **Authorized official:** CHRIS DEDEAUX (CLINIC ADMINISTRATOR)
- **Authorized official phone:** (622) 256-7112

## Contact information

- **Practice address:** 518 WEST DR, OKOLONA, MS 38860-1624
- **Practice address phone:** (662) 447-2255
- **Mailing address:** 123 MAIN ST N, AMORY, MS 38821-3416

## Taxonomy

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

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 08/22/2020