Organization
MISSISSIPPI FAMILY MEDICINE P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA DEARMAN (INSURANCE CLERK)
(601) 671-8555
Entity
Organization
Contact information
Practice address
940 MATTHEW DR, SUITE 2, WAYNESBORO, MS 39367-2522
(601) 671-8555
(601) 671-0777
Mailing address
940 MATTHEW DR, SUITE 2, WAYNESBORO, MS 39367-2522
(601) 671-8555
(601) 671-0777
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00964
DR. STOKLEY
AL
01
—
009700450
DR. TYNES
AL
01
—
009926375
DR. STROKLEY
AL
05
—
0113843
—
MS
05
—
0117444
—
MS
01
—
073075294TYN
DR. TYNES
AL
01
—
279588
DR. TYNES
MS
01
—
C02214
MEDICARE PROVIDER ID
MS
01
—
CD1005
PALMETTOGBA - RAILROAD MEDICARE
—
Enumeration date
01/11/2007
Last updated
07/20/2010
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