Organization
YOUR FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL TAMOUR MOORE PH.D. (OWNER)
(601) 544-8935
Entity
Organization
Contact information
Practice address
514 OLD RICHTON RD, PETAL, MS 39465-2920
(601) 544-8935
(601) 544-8935
Mailing address
67 MARS HILL RD, PETAL, MS 39465-8343
(601) 544-8935
(601) 544-8935
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
948493
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861400244
—
MS
Enumeration date
12/03/2014
Last updated
12/03/2014
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