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General NPI Number Information
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NPI Number | 1285827071
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Entity Type | Organization
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Legal Business Name | MOSS POINT FOOT CLINIC, LLC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 4316 MCINNIS AVE
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City | MOSS POINT
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State | MS
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Zip | 39563-2812
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Country | US
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Telephone | 228-474-2606
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Fax | 228-474-2606
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Provider Business Mailing Address
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Address Line | 4316 MCINNIS AVE
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City | MOSS POINT
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State | MS
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Zip | 39563-2812
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Country | US
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Telephone | 228-474-2606
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Fax | 228-474-2606
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWIN ESSIEN
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Credential | DPM
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Telephone | 228-474-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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