Organization
CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.
Active
Organization
CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONEY L JOHNSON (CHIEF EXECUTIVE OFFICER)
(601) 437-3052
Entity
Organization
Contact information
Practice address
2045 HIGHWAY 61 N, PORT GIBSON, MS 39150-4262
(601) 437-3049
(601) 437-3051
Mailing address
PO BOX 741, PORT GIBSON, MS 39150-0741
(601) 437-3049
(601) 437-3051
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
MS
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013386
—
MS
Enumeration date
04/09/2009
Last updated
04/09/2009
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