Organization
CANTON FAMILY CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY LOUSTEAU (CLINIC ADMINISTRATOR)
(601) 859-2611
Entity
Organization
Contact information
Practice address
120 E ACADEMY ST, CANTON, MS 39046-4502
(601) 859-2611
Mailing address
120 E ACADEMY ST, CANTON, MS 39046-4502
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
09015552
MS
Other
Enumeration date
11/27/2007
Last updated
03/03/2010
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