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General NPI Number Information
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NPI Number | 1124436977
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Entity Type | Organization
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Legal Business Name | CRESCENTWORLD ENTERPRISES, PLLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 406 BRIARWOOD DR STE 401
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City | JACKSON
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State | MS
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Zip | 39206-3063
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Country | US
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Telephone | 601-707-7899
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Fax | 866-304-0148
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Provider Business Mailing Address
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Address Line | PO BOX 5025
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City | JACKSON
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State | MS
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Zip | 39296-5025
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Country | US
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Telephone | 601-707-7899
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Fax | 866-304-0148
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | BERTHRONE MOCK-MUHAMMAD
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Credential | MD, FACC
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Telephone | 601-707-7899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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