Organization
OLIVE BRANCH FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY GREEN (BUSINESS OFFICE MANAGER)
(662) 893-8484
Entity
Organization
Contact information
Practice address
9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
(662) 895-4949
(662) 895-6776
Mailing address
9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
(662) 895-4949
(662) 895-6776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629018478
NPI
—
Enumeration date
06/08/2006
Last updated
12/21/2020
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