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General NPI Number Information
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NPI Number | 1598419640
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Entity Type | Organization
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Legal Business Name | SERENITY FITNESS COMPLEX, INC.
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 208-B CHURCH STREET
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City | PORT GIBSON
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State | MS
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Zip | 39150
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Country | US
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Telephone | 601-448-5041
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Fax |
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Provider Business Mailing Address
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Address Line | 306 CHURCH ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2108
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Country | US
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Telephone | 601-415-5921
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DOROTHY JEANETTE FELTON
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Credential | NURSE
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Telephone | 601-415-5921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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