Organization
CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.
Active
Other names
P G Middle School School Base Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LADONNA DAVIS (CHIEF OPERATING OFFICER)
(601) 437-3050
Entity
Organization
Contact information
Practice address
161 RAMSEY DR, 2045 HIGHWAY 61 NORTH, PORT GIBSON, MS 39150-2531
(601) 437-9021
(601) 437-3051
Mailing address
2045 HIGHWAY 61 N, P O BOX 741, PORT GIBSON, MS 39150-4262
(601) 437-9021
(601) 437-3051
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03907367
—
MS
Enumeration date
07/24/2008
Last updated
12/19/2011
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