| Reservoir Family Medical Clinic, Pa | |
|
1679 Old Fannin Rd Ste E Flowood MS 39232-8101 | |
| (601) 992-6511 | |
| (601) 992-5684 |
| Full Name | Reservoir Family Medical Clinic, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1679 Old Fannin Rd Ste E, Flowood, Mississippi |
| Authorized Official Name and Position | Charles Naurice Crenshaw (OWNER/PHYSICAN) |
| Authorized Official Contact | 6019926511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reservoir Family Medical Clinic, Pa 1679 Old Fannin Rd Ste E Flowood MS 39232-8101 Ph: (601) 992-6511 | Reservoir Family Medical Clinic, Pa 1679 Old Fannin Rd Ste E Flowood MS 39232-8101 Ph: (601) 992-6511 |
| NPI Number | 1770929713 |
|---|---|
| Provider Enumeration Date | 05/17/2013 |
| Last Update Date | 05/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770929713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 09099 (Mississippi) | Primary |
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