Provider Demographics
NPI:1932453610
Name:CONVENIENT CARE OF FULTON INC
Entity Type:Organization
Organization Name:CONVENIENT CARE OF FULTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-862-4422
Mailing Address - Street 1:1301 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8862
Mailing Address - Country:US
Mailing Address - Phone:662-862-4422
Mailing Address - Fax:662-862-4244
Practice Address - Street 1:1301 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8862
Practice Address - Country:US
Practice Address - Phone:662-862-4422
Practice Address - Fax:662-862-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty