Healthcare Provider Details

I. General information

NPI: 1073803151
Provider Name (Legal Business Name): URBAN MIDWIFERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WINTERGREEN DR
BEAUFORT SC
29906-8994
US

IV. Provider business mailing address

93 WINTERGREEN DR
BEAUFORT SC
29906-8994
US

V. Phone/Fax

Practice location:
  • Phone: 888-514-3055
  • Fax:
Mailing address:
  • Phone: 888-514-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLMW-0048
License Number StateSC

VIII. Authorized Official

Name: MRS. JAYVON DUPREE MUHAMMAD
Title or Position: EXECUTIVE DIRECTOR/LICENSED MIDWIFE
Credential: LM, CPM
Phone: 888-514-3055