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General NPI Number Information
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NPI Number | 1104665041
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Entity Type | Organization
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Legal Business Name | AN MEDI-ZEN, PLLC
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 124 S. BROADWAY STREET SUITE 1
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City | GREENVILLE
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State | MS
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Zip | 38701
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Country | US
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Telephone | 662-877-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 2130A PEARMAN ROAD
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City | BOYLE
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State | MS
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Zip | 38730-9770
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Country | US
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Telephone | 662-877-5555
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST, DOCTOR/ OWNER
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Name | SHARON JOHNSON-EBY
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Credential | LAC., DCM
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Telephone | 662-877-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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