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General NPI Number Information
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NPI Number | 1184241812
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Entity Type | Organization
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Legal Business Name | MOSS POINT VISIONARY CIRCLE INC
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 4425 GRIFFIN ST
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City | MOSS POINT
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State | MS
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Zip | 39563-3707
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Country | US
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Telephone | 601-345-1903
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 GRIFFIN ST
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City | MOSS POINT
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State | MS
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Zip | 39563-3707
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Country | US
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Telephone | 601-345-1903
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Fax |
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Authorized Official
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Title or Position | PROJECT DIRECTOR
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Name | MR. CHRISTOPHER CARTER
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Credential |
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Telephone | 601-345-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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