=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083807218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBER L. CLANTON LLC DBA HEALTHWISE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2007
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6955 OLD CANTON RD STE L
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-1267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-899-5642
-----------------------------------------------------
Fax | 601-899-5643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6955 OLD CANTON RD STE L
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-1267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-899-5642
-----------------------------------------------------
Fax | 601-899-5643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. AMBER L. CLANTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-899-5462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------