Healthcare Provider Details

I. General information

NPI: 1073018123
Provider Name (Legal Business Name): CG & CO AMERICAN GIRL US 7 STAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 EAST WOODLAWN AVENUE
NATCHEZ MS
39120-4877
US

IV. Provider business mailing address

48 EAST WOODLAWN AVENUE
NATCHEZ MS
39120-4877
US

V. Phone/Fax

Practice location:
  • Phone: 601-304-2043
  • Fax:
Mailing address:
  • Phone: 601-304-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR863813
License Number StateMS

VIII. Authorized Official

Name: MS. TARSHA CARTER AMBEAU
Title or Position: OWNER/CEO
Credential:
Phone: 601-304-2043