Healthcare Provider Details

I. General information

NPI: 1467722652
Provider Name (Legal Business Name): EVELYN HIV WORLD CONSULT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 CUSTER DR
SOUTHAVEN MS
38671-5018
US

IV. Provider business mailing address

2072 CUSTER DR
SOUTHAVEN MS
38671-5018
US

V. Phone/Fax

Practice location:
  • Phone: 800-781-1956
  • Fax: 888-690-1333
Mailing address:
  • Phone: 800-781-1956
  • Fax: 888-690-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN C DOBSON
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 800-781-1956