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1 Medical Park Dr Fulton MS 38843-9001 | |
| (662) 862-5200 | |
| (662) 862-2755 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Medical Park Dr, Fulton, Mississippi |
| Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
| Authorized Official Contact | 6623774229 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-2774 | 1 Medical Park Dr Fulton MS 38843-9001 Ph: (662) 862-5200 |
| NPI Number | 1467557868 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 01/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467557868 | NPI | - | NPPES |
| 009013620 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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