Organization
CLAIBORNE COUNTY FAMILY HEALTH CENTER
Active
Other names
CCFHC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LADONNA BEASLEY DAVIS (CHIEF OPERATING OFFICER)
(601) 437-3052
Entity
Organization
Contact information
Practice address
2045 HIGHWAY 61 NORTH, PORT GIBSON, MS 39150-4262
(601) 437-3049
(601) 437-3051
Mailing address
2045 HIGHWAY 61 N, P O BOX 741, PORT GIBSON, MS 39150-4262
(601) 437-3049
(601) 437-3051
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09010054
—
MS
Enumeration date
06/10/2005
Last updated
09/24/2013
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