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General NPI Number Information
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NPI Number | 1699649251
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Entity Type | Individual
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Provider Name | MR. JA'ALJUAN R GREER
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Gender | Male
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 5605 TUCKER LANDING DR
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City | HORN LAKE
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State | MS
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Zip | 38637-1087
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Country | US
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Telephone | 662-420-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 TUCKER LANDING DR
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City | HORN LAKE
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State | MS
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Zip | 38637-1087
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Country | US
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Telephone | 662-420-0185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number | 6112
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 6239
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License Number State | MS
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