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General NPI Number Information
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NPI Number | 1295319424
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Entity Type | Organization
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Legal Business Name | NORTH MISSISSIPPI TELEHEALTH CONSULTING LLC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 7900 AIRWAYS BLVD STE 6
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4113
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Country | US
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Telephone | 847-276-0160
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Fax |
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Provider Business Mailing Address
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Address Line | 170 DANBROOKE DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-8624
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Country | US
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Telephone | 847-276-0160
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MS. KIMBERLY M DUWALDT
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Credential |
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Telephone | 662-200-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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