| Legacy Family Care Clinic | |
|
6798 U S Highway 98 Ste 30 Hattiesburg MS 39402-7987 | |
| (601) 596-9053 | |
| (601) 336-6615 |
| Full Name | Legacy Family Care Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 6798 U S Highway 98 Ste 30, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Tarah Chatham (OWNER) |
| Authorized Official Contact | 6015969053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Family Care Clinic 6798 U S Highway 98 Ste 30 Hattiesburg MS 39402-7987 Ph: (601) 596-9053 | Legacy Family Care Clinic 6798 U S Highway 98 Ste 30 Hattiesburg MS 39402-7987 Ph: (601) 596-9053 |
| NPI Number | 1003620675 |
|---|---|
| Provider Enumeration Date | 02/04/2025 |
| Last Update Date | 06/12/2025 |
| Medicare PECOS PAC ID | 5991215451 |
|---|---|
| Medicare Enrollment ID | O20250612001441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003620675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tarah Vakili Chatham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811355605 PECOS PAC ID: 9537464946 Enrollment ID: I20160223001970 |
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