Healthcare Provider Details

I. General information

NPI: 1124436977
Provider Name (Legal Business Name): CRESCENTWORLD ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 BRIARWOOD DR STE 401
JACKSON MS
39206-3063
US

IV. Provider business mailing address

PO BOX 5025
JACKSON MS
39296-5025
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-7899
  • Fax: 866-304-0148
Mailing address:
  • Phone: 601-707-7899
  • Fax: 866-304-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: BERTHRONE MOCK-MUHAMMAD
Title or Position: PHYSICIAN OWNER
Credential: MD, FACC
Phone: 601-707-7899