Provider Demographics
NPI:1669637666
Name:FAMILY MEDICINE ASSOCIATES OF NATCHEZ, PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF NATCHEZ, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-445-7773
Mailing Address - Street 1:46 SEARGENT S PRENTISS DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-445-7773
Mailing Address - Fax:601-455-5911
Practice Address - Street 1:46 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-445-7773
Practice Address - Fax:601-445-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-20
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08855341Medicaid