# OLIVE BRANCH PRIMARY CARE, PLLC

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

## Provider details

- **NPI number:** 1871918789
- **Authorized official:** KAREN M TATE (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (662) 895-3700

## Contact information

- **Practice address:** 7163 GOODMAN RD, OLIVE BRANCH, MS 38654-1904
- **Practice address phone:** (662) 895-3700
- **Practice address fax:** (662) 895-4886
- **Mailing address:** 1405 NOTTINGHAM DR, SOUTHAVEN, MS 38671-9474
- **Mailing address phone:** (662) 349-0406
- **Mailing address fax:** (662) 349-0406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2014
- **Last updated:** 02/28/2014