Organization
LUCEDALE FAMILY MEDICAL CLINIC
Active
Other names
Lucedale Family Medical Clinic, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGOT PETERS (BILLING DIRECTOR)
(251) 445-7618
Entity
Organization
Contact information
Practice address
223 WINTER ST STE D, LUCEDALE, MS 39452-6078
(601) 791-5012
(601) 791-5013
Mailing address
6577 CREEL RD, THEODORE, AL 36582-3857
(251) 725-8455
(251) 445-3722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
05/10/2024
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