Healthcare Provider Details

I. General information

NPI: 1114911765
Provider Name (Legal Business Name): ANNIE HOBSON WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 TERRY RD SUITE 13
JACKSON MS
39212-3073
US

IV. Provider business mailing address

2941 TERRY RD SUITE 13
JACKSON MS
39212-3073
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-6419
  • Fax: 601-373-3257
Mailing address:
  • Phone: 601-373-6419
  • Fax: 601-373-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE MCFIELD SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-373-6419