| Southern Charm Family Healthcare Llc | |
|
1201 Highway 49 S Ste 46 Richland MS 39218-9438 | |
| (601) 829-6151 | |
| (769) 241-0044 |
| Full Name | Southern Charm Family Healthcare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1201 Highway 49 S Ste 46, Richland, Mississippi |
| Authorized Official Name and Position | Kelli Marie Foster (OWNER) |
| Authorized Official Contact | 6018296151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Charm Family Healthcare Llc 515 Belle Oak Pl Brandon MS 39042-8111 Ph: (601) 829-6151 | Southern Charm Family Healthcare Llc 1201 Highway 49 S Ste 46 Richland MS 39218-9438 Ph: (601) 829-6151 |
| NPI Number | 1801471172 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 12/08/2021 |
| Medicare PECOS PAC ID | 4082004742 |
|---|---|
| Medicare Enrollment ID | O20211213000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801471172 | NPI | - | NPPES |
| 00936767 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Esquanickia Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407390438 PECOS PAC ID: 2668755042 Enrollment ID: I20170209000063 |
| Provider Name | Cris A Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306454442 PECOS PAC ID: 3577962976 Enrollment ID: I20210603002976 |
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