Organization
UNIVERSITY FAMILY MEDICINE ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE BEEBE MD (CHAIRMAN)
(601) 984-5404
Entity
Organization
Contact information
Practice address
1410 E WOODROW WILSON AVE, JACKSON, MS 39216-5114
(601) 984-5404
(601) 815-3771
Mailing address
PO BOX 4999, JACKSON, MS 39296-4999
(601) 984-5404
(601) 815-3771
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014106
—
MS
05
—
09014130
—
MS
Enumeration date
07/05/2007
Last updated
08/22/2020
Update your record
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