Provider Demographics
NPI:1831608686
Name:COMPLETE FAMILY MEDICAL, LLC
Entity type:Organization
Organization Name:COMPLETE FAMILY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-748-6238
Mailing Address - Street 1:201 HIGHWAY 51 N STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2653
Mailing Address - Country:US
Mailing Address - Phone:601-833-5333
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHWAY 51 N STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2653
Practice Address - Country:US
Practice Address - Phone:601-833-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902069363LF0000X
MSR871958363LF0000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty