Provider Demographics
NPI:1386916146
Name:GREENFIELD FAMILY HEALTHCARE INC
Entity type:Organization
Organization Name:GREENFIELD FAMILY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:AYCOCK
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-824-0988
Mailing Address - Street 1:762 HIGHWAY 468
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9058
Mailing Address - Country:US
Mailing Address - Phone:601-824-0988
Mailing Address - Fax:601-824-0987
Practice Address - Street 1:762 HIGHWAY 468
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-9058
Practice Address - Country:US
Practice Address - Phone:601-824-0988
Practice Address - Fax:601-824-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR624055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120346Medicaid
MS0120346Medicaid
MS500000609Medicare PIN