Healthcare Provider Details

I. General information

NPI: 1376168500
Provider Name (Legal Business Name): MS CARE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S PEAR ORCHARD RD STE B
RIDGELAND MS
39157-4836
US

IV. Provider business mailing address

625 S PEAR ORCHARD RD STE B
RIDGELAND MS
39157-4836
US

V. Phone/Fax

Practice location:
  • Phone: 601-850-2200
  • Fax: 601-420-0223
Mailing address:
  • Phone: 601-499-0282
  • Fax: 601-420-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA GREENE
Title or Position: CEO/PRESIDENT
Credential: DNP, NP-C
Phone: 601-499-0282