Healthcare Provider Details

I. General information

NPI: 1679171995
Provider Name (Legal Business Name): NEW HOPE MEDICAL PRIMARY & URGENT CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 02/18/2021
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 TENNESSEE GAS RD
GREENVILLE MS
38701-8143
US

IV. Provider business mailing address

1850 LAKE MANOR DR
GREENVILLE MS
38701-7439
US

V. Phone/Fax

Practice location:
  • Phone: 662-822-0270
  • Fax:
Mailing address:
  • Phone: 662-822-0270
  • Fax: 662-537-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOPE WILLIAMS-BROWN
Title or Position: OWNER
Credential: NP
Phone: 662-822-0270