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General NPI Number Information
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NPI Number | 1376168500
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Entity Type | Organization
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Legal Business Name | MS CARE CLINIC, INC
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 625 S PEAR ORCHARD RD STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-4836
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Country | US
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Telephone | 601-850-2200
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Fax | 601-420-0223
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Provider Business Mailing Address
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Address Line | 625 S PEAR ORCHARD RD STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-4836
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Country | US
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Telephone | 601-499-0282
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Fax | 601-420-0223
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. AMANDA GREENE
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Credential | DNP, NP-C
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Telephone | 601-499-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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