Healthcare Provider Details

I. General information

NPI: 1093348161
Provider Name (Legal Business Name): AMH SERIES II, HI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ULUNIU ST STE D
KAILUA HI
96734-2503
US

IV. Provider business mailing address

3085 FOUNTAINSIDE DR STE 107
GERMANTOWN TN
38138-7842
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-5783
  • Fax:
Mailing address:
  • Phone: 901-757-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WILLIAMS
Title or Position: CREDENTIALING
Credential:
Phone: 901-757-5783