Provider Demographics
NPI:1124185129
Name:G A CARMICHAEL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:G A CARMICHAEL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-859-5213
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0588
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:601-859-8771
Practice Address - Street 1:1421 E PEACE ST STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4938
Practice Address - Country:US
Practice Address - Phone:601-855-2516
Practice Address - Fax:601-859-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03971398Medicaid
MSC00964Medicare PIN
251935Medicare Oscar/Certification