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General NPI Number Information
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NPI Number | 1659105955
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Entity Type | Organization
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Legal Business Name | EMERALD WELL, PLLC
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 930 LAMAR AVE STE 10
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City | YAZOO CITY
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State | MS
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Zip | 39194-3242
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Country | US
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Telephone | 601-672-9730
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Fax |
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Provider Business Mailing Address
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Address Line | 3545 FOREST DR
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City | GREENVILLE
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State | MS
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Zip | 38703-8202
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Country | US
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Telephone | 601-672-9730
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CENTERIA GREEN WOOLFOLK
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Credential |
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Telephone | 601-672-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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