| Mettetal Family Medicine | |
|
401 E Lee St Sardis MS 38666-1227 | |
| (662) 487-0004 | |
| (662) 487-0006 |
| Full Name | Mettetal Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 401 E Lee St, Sardis, Mississippi |
| Authorized Official Name and Position | Penny Harrison (OFFICE MANAGER) |
| Authorized Official Contact | 6624870004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mettetal Family Medicine 401 E Lee St Sardis MS 38666-1227 Ph: (662) 487-0004 | Mettetal Family Medicine 401 E Lee St Sardis MS 38666-1227 Ph: (662) 487-0004 |
| NPI Number | 1083786727 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 06/01/2023 |
| Medicare PECOS PAC ID | 3072591791 |
|---|---|
| Medicare Enrollment ID | O20040709000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083786727 | NPI | - | NPPES |
| 09015623 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Mississippi) | Primary |
| Provider Name | Cary N Mettetal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235102674 PECOS PAC ID: 4880672500 Enrollment ID: I20110401000159 |
| Provider Name | Laura E Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619226032 PECOS PAC ID: 2860637519 Enrollment ID: I20130328000396 |
| Provider Name | Lisa M. Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346794260 PECOS PAC ID: 9830485325 Enrollment ID: I20160909000488 |
| Provider Name | Jessica Downs Tubbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124574231 PECOS PAC ID: 4587943873 Enrollment ID: I20161109000265 |
| Provider Name | Cody Renaldo Gullick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205319530 PECOS PAC ID: 3678826716 Enrollment ID: I20181019000351 |
| Provider Name | Kelly D Grace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538631700 PECOS PAC ID: 9638418221 Enrollment ID: I20190226001014 |
Sardis Family Medical Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 124 S Main St, Sardis, MS 38666 Phone: 662-487-1064 |