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General NPI Number Information
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NPI Number | 1205981578
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Entity Type | Organization
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Legal Business Name | KHARI A OMOLARA PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 317 HIGHLAND BLVD STE S
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City | NATCHEZ
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State | MS
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Zip | 39120-4636
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Country | US
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Telephone | 601-445-1922
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Fax | 601-445-1923
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | BROOKHAVEN
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State | MS
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Zip | 39603-7129
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Country | US
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Telephone | 601-445-1922
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Fax | 601-445-1923
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHARI ABAYOMI OMOLARA
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Credential | M.D.
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Telephone | 601-573-9471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17619
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License Number State | MS
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