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General NPI Number Information
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NPI Number | 1639580186
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Entity Type | Organization
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Legal Business Name | MUMFORD TELEHEALTH SERVICES
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 05/17/2014
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Provider Practice Location Address
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Address Line | 4113 FENWICK VILLAGE DR
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City | SAVANNAH
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State | GA
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Zip | 31419-5513
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Country | US
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Telephone | 912-844-6497
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Fax |
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Provider Business Mailing Address
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Address Line | 4113 FENWICK VILLAGE DR
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City | SAVANNAH
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State | GA
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Zip | 31419-5513
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Country | US
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Telephone | 912-844-6497
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. PENNICA MUMFORD MUMFORD
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Credential | RN
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Telephone | 912-844-6497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN168735
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | RN168735
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | RN168735
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | RN168735
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | RN168735
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RN168735
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License Number State | GA
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