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General NPI Number Information
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NPI Number | 1376703207
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Entity Type | Organization
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Legal Business Name | HEALTHY FUTURE INC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 708 MONTLIMAR PARK SUITE E4
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City | MOBILE
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State | AL
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Zip | 36693-5141
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Country | US
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Telephone | 219-588-8006
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Fax | 877-268-7979
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Provider Business Mailing Address
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Address Line | 1626 WILCOX AVE SUITE 641
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City | LOS ANGELES
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State | CA
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Zip | 90028-6234
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Country | US
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Telephone | 219-588-8006
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALTO LOFTIN JACKSON JR.
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Credential | MD
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Telephone | 219-588-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD6899
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License Number State | AL
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