Healthcare Provider Details

I. General information

NPI: 1609090802
Provider Name (Legal Business Name): AMORY HMA PHYSICIAN MGMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EARL FRYE BLVD
AMORY MS
38821-5500
US

IV. Provider business mailing address

123 MAIN ST N
AMORY MS
38821-3416
US

V. Phone/Fax

Practice location:
  • Phone: 662-257-6771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY LINLEY
Title or Position: CLINIC ADMIN ASSISTANT
Credential:
Phone: 662-256-7112