Reservoir Family Medical Clinic, Pa | |
1679 Old Fannin Rd Ste E Flowood MS 39232-8101 | |
(601) 992-6511 | |
(601) 992-5684 |
Full Name | Reservoir Family Medical Clinic, Pa |
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Speciality | Family Medicine |
Location | 1679 Old Fannin Rd Ste E, Flowood, Mississippi |
Authorized Official Name and Position | Charles Naurice Crenshaw (OWNER/PHYSICAN) |
Authorized Official Contact | 6019926511 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Reservoir Family Medical Clinic, Pa 1679 Old Fannin Rd Ste E Flowood MS 39232-8101 Ph: (601) 992-6511 | Reservoir Family Medical Clinic, Pa 1679 Old Fannin Rd Ste E Flowood MS 39232-8101 Ph: (601) 992-6511 |
NPI Number | 1770929713 |
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Provider Enumeration Date | 05/17/2013 |
Last Update Date | 05/29/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770929713 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 09099 (Mississippi) | Primary |
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