Healthcare Provider Details

I. General information

NPI: 1659673606
Provider Name (Legal Business Name): DIAMONDHEAD URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E ALOHA DR SUITE 16
DIAMONDHEAD MS
39525-3349
US

IV. Provider business mailing address

4402 E ALOHA DR SUITE 16
DIAMONDHEAD MS
39525-3349
US

V. Phone/Fax

Practice location:
  • Phone: 228-364-9001
  • Fax: 228-364-9004
Mailing address:
  • Phone: 228-364-9001
  • Fax: 228-364-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES W EMBRY
Title or Position: CEO/FAMILY NURSE PRACTITIONER,
Credential: FNP-C
Phone: 337-344-4492