Healthcare Provider Details

I. General information

NPI: 1982126983
Provider Name (Legal Business Name): ALOHA PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E ALOHA DR STE 15
DIAMONDHEAD MS
39525-3305
US

IV. Provider business mailing address

4402 E ALOHA DR STE 15
DIAMONDHEAD MS
39525-3305
US

V. Phone/Fax

Practice location:
  • Phone: 228-222-5060
  • Fax: 228-364-9004
Mailing address:
  • Phone: 228-222-5060
  • Fax: 228-364-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. JAMES W EMBRY
Title or Position: OWNER/NURSE PRACTITIONER
Credential: N.P.
Phone: 228-364-9001