Healthcare Provider Details

I. General information

NPI: 1346300423
Provider Name (Legal Business Name): AMNUEY M CHIEMPRABHA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MANGUM AVE
MENDENHALL MS
39114
US

IV. Provider business mailing address

PO BOX 295
MENDENHALL MS
39114
US

V. Phone/Fax

Practice location:
  • Phone: 601-847-5066
  • Fax: 601-847-0149
Mailing address:
  • Phone: 601-847-5066
  • Fax: 601-847-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number08142
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08142
License Number StateMS

VIII. Authorized Official

Name: AMNUEY M CHIEMPRABHA
Title or Position: PRESIDENT
Credential: MD
Phone: 601-847-5066