Provider Demographics
NPI:1043825110
Name:PREMIER FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-560-3874
Mailing Address - Street 1:109 HIDDEN HOLW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1493 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:MS
Practice Address - Zip Code:39045-9524
Practice Address - Country:US
Practice Address - Phone:769-666-9162
Practice Address - Fax:877-760-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care