| Organization Name: | NETTLETON FAMILY MEDICAL CLINIC, INC. |
| NPI Number: | 1003005125 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW CURRY JUSTICE (OWNER) |
| Mailing Address: | 1495 Maple Rd Nettleton |
| State: | MS US |
| Postal Code: | 388586026 |
| Phone Number: | 6629639146 |
| Fax Number: | 6629639186 |
| NPI Enumeration Date: | 10/15/2007 |
| NPI Last Update Date: | 11/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R682403 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |