Provider Demographics
NPI:1598306920
Name:TOTAL HEALTHCARE CLINIC LLC
Entity Type:Organization
Organization Name:TOTAL HEALTHCARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-321-9453
Mailing Address - Street 1:2964 TERRY RD STE B-1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3070
Mailing Address - Country:US
Mailing Address - Phone:601-321-9453
Mailing Address - Fax:601-398-4699
Practice Address - Street 1:2964 TERRY RD STE B1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3070
Practice Address - Country:US
Practice Address - Phone:601-321-9453
Practice Address - Fax:601-398-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty