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RESERVOIR FAMILY MEDICAL CLINIC, PA
NPI 1770929713
Family Medicine in Flowood, MS

Active since May 17, 2013
1679 OLD FANNIN RD STE E, FLOWOOD, MS 39232(601) 992-6511(601) 992-5684 Get Directions Write a Review

NPPES record last updated: May 29, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Reservoir Family Medical Clinic, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RESERVOIR FAMILY MEDICAL CLINIC, PA (NPI 1770929713) is a healthcare organization registered as a family medicine in Flowood, Mississippi and active in the NPI registry since May 2013. The organization lists Charles Naurice Crenshaw, Owner/physican, as its authorized official.

NPPES Registry Identity

NPI1770929713
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRESERVOIR FAMILY MEDICAL CLINIC, PA
Location Address1679 OLD FANNIN RD STE EFlowood, MS 39232-8101
Mailing Address1679 Old Fannin Rd Ste EFlowood, MS 39232-8101 · (601) 992-6511 · Fax (601) 992-5684
Phone(601) 992-6511
Fax(601) 992-5684
Organization SubpartNo
Authorized OfficialCharles Naurice CrenshawOwner/physican · (601) 992-6511
Enumeration DateMay 17, 2013
Last NPPES UpdateMay 29, 2013
✔ NPI 1770929713 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MS · 09099
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1679 OLD FANNIN RD STE E, Flowood, MS 39232
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Other Identifiers 1

Medicare UPINB30608MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. TARAN KAUR FNP
Nurse Practitioner (Family)
1679 OLD FANNIN RD STE E
FLOWOOD, MS 39232
Rankin County (601) 398-1949
ANGELA B. SHANNON M.D.
Pediatrics (Pediatric Gastroenterology)
1679 OLD FANNIN RD STE E
FLOWOOD, MS 39232
Rankin County (601) 398-1949
HAPPY TUMMIES PA
Pediatrics (Pediatric Gastroenterology)
1679 OLD FANNIN RD STE E
FLOWOOD, MS 39232
Rankin County (601) 398-1949

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Reservoir Family Medical Clinic, PA's NPI number?

The NPI number for Reservoir Family Medical Clinic, PA is 1770929713. It was assigned to this organization in the NPPES registry on May 17, 2013.

Where is Reservoir Family Medical Clinic, PA located?

Reservoir Family Medical Clinic, PA is located at 1679 Old Fannin Rd Ste E, Flowood, MS 39232. The listed phone number is (601) 992-6511.

What is Reservoir Family Medical Clinic, PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Reservoir Family Medical Clinic, PA was last updated on May 29, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.