Healthcare Provider Details

I. General information

NPI: 1700830494
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTHCARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 GLENDALE AVE
HATTIESBURG MS
39401-1073
US

IV. Provider business mailing address

PO BOX 15613
HATTIESBURG MS
39404-5613
US

V. Phone/Fax

Practice location:
  • Phone: 601-582-5805
  • Fax: 601-582-5806
Mailing address:
  • Phone: 601-582-5805
  • Fax: 601-582-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14600
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number14600
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number14600
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number17488
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17488
License Number StateMS

VIII. Authorized Official

Name: AKWASI A AMPONSAH
Title or Position: CEO
Credential: MD
Phone: 601-582-5805