Provider Demographics
NPI:1487196515
Name:G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:ED D
Authorized Official - Phone:601-859-5213
Mailing Address - Street 1:10340 HIGHWAY 433 W
Mailing Address - Street 2:
Mailing Address - City:BENTONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39040-9416
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:601-859-8771
Practice Address - Street 1:10340 HIGHWAY 433 W
Practice Address - Street 2:
Practice Address - City:BENTONIA
Practice Address - State:MS
Practice Address - Zip Code:39040
Practice Address - Country:US
Practice Address - Phone:662-755-2518
Practice Address - Fax:601-859-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09207040Medicaid