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General NPI Number Information
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NPI Number | 1578133278
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Entity Type | Organization
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Legal Business Name | SOUTHERN DIABETES CARE, PLLC
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Dates
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Enumeration Date | 06/26/2021
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 2785 HIGHWAY 49 S STE B
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City | FLORENCE
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State | MS
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Zip | 39073-9411
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Country | US
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Telephone | 601-832-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 HIGHWAY 469 S
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City | FLORENCE
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State | MS
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Zip | 39073-9068
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Country | US
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Telephone | 601-832-2616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE LEEMAE BREWER
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Credential | FNP-C
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Telephone | 601-832-2616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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