# DESOTO FAMILY CARE CLINIC, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Desoto Family Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972028843
- **Authorized official:** DIOSAN MANGUBAT POWELL (MSN)
- **Authorized official phone:** (662) 510-5353

## Contact information

- **Practice address:** 346 STATELINE RD W, SOUTHAVEN, MS 38671-1610
- **Practice address phone:** (662) 510-5353
- **Practice address fax:** (662) 510-0409
- **Mailing address:** 5248 GARNER LN, SOUTHAVEN, MS 38672-6016
- **Mailing address phone:** (662) 510-5353
- **Mailing address fax:** (662) 510-0409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 901872 | MS | Yes |

## Other

- **Enumeration date:** 08/11/2017
- **Last updated:** 03/10/2023