Organization
BOUNDS FAMILY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA HALFORD (COORDINATOR)
(601) 807-9550
Entity
Organization
Contact information
Practice address
821 MAIN ST, FAYETTE, MS 39069-5695
(601) 809-0882
(601) 809-0883
Mailing address
PO BOX 91, FAYETTE, MS 39069-0091
(601) 809-0882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07583381
—
MS
Enumeration date
02/21/2019
Last updated
07/22/2021
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