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General NPI Number Information
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NPI Number | 1659673606
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Entity Type | Organization
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Legal Business Name | DIAMONDHEAD URGENT CARE
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 4402 E ALOHA DR SUITE 16
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3349
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Country | US
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Telephone | 228-364-9001
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Fax | 228-364-9004
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Provider Business Mailing Address
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Address Line | 4402 E ALOHA DR SUITE 16
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3349
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Country | US
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Telephone | 228-364-9001
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Fax | 228-364-9004
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Authorized Official
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Title or Position | CEO/FAMILY NURSE PRACTITIONER,
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Name | MR. JAMES W EMBRY
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Credential | FNP-C
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Telephone | 337-344-4492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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