Provider Demographics
NPI:1326239278
Name:CORINTH FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:CORINTH FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:WIGGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-415-4762
Mailing Address - Street 1:1921 DROKE RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6604
Mailing Address - Country:US
Mailing Address - Phone:662-415-4762
Mailing Address - Fax:
Practice Address - Street 1:1921 DROKE RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6604
Practice Address - Country:US
Practice Address - Phone:662-415-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty