Organization
SHANNON FAMILY MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORRIS N DOSS FNP (OWNER)
(662) 995-2201
Entity
Organization
Contact information
Practice address
219 BROAD ST, SHANNON, MS 38868
(662) 995-2201
(662) 995-2202
Mailing address
219 BROAD ST, SHANNON, MS 38868-9301
(662) 995-2201
(662) 995-2202
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
R819576
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05188209
—
MS
Enumeration date
03/13/2008
Last updated
06/25/2018
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