Healthcare Provider Details

I. General information

NPI: 1821308214
Provider Name (Legal Business Name): JONATHAN HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 WISCONSIN AVE
VICKSBURG MS
39180-5331
US

IV. Provider business mailing address

3444 WISCONSIN AVE
VICKSBURG MS
39180-5331
US

V. Phone/Fax

Practice location:
  • Phone: 601-638-0031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: