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General NPI Number Information
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NPI Number | 1558728469
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Entity Type | Organization
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Legal Business Name | LIFE TRANSFORMATION MEDICAL CENTER LLC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 806 EARL FRYE BLVD
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City | AMORY
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State | MS
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Zip | 38821-5505
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Country | US
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Telephone | 662-597-9000
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Fax | 662-257-2083
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Provider Business Mailing Address
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Address Line | 806 EARL FRYE BLVD
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City | AMORY
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State | MS
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Zip | 38821-5505
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Country | US
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Telephone | 662-597-9000
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Fax | 662-257-2083
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CRISSY HARMON
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Credential |
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Telephone | 662-597-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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