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General NPI Number Information
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NPI Number | 1689231367
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Entity Type | Organization
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Legal Business Name | CHRIST UNITED MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 2750 N CHURCH AVE
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City | LOUISVILLE
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State | MS
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Zip | 39339-2054
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Country | US
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Telephone | 662-446-9012
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Fax | 662-446-9432
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Provider Business Mailing Address
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Address Line | 9573 HIGHWAY 490
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City | LOUISVILLE
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State | MS
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Zip | 39339-9192
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Country | US
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Telephone | 662-446-9012
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Fax |
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Authorized Official
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Title or Position | FNP-C, CLINIC ADMINISTRATOR
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Name | ALYSSA CAMERON WHITEHEAD
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Credential | FNP-C
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Telephone | 662-446-9012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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