| Organization Name: | GREENE COUNTY FAMILY MEDICAL CLINIC |
| NPI Number: | 1689821126 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHY FENDER (ADMINISTRATOR) |
| Mailing Address: | 1017 Jackson Ave Leakesville |
| State: | MS US |
| Postal Code: | 394519105 |
| Phone Number: | 6013942820 |
| Fax Number: | 6013942827 |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 03/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 11343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |