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General NPI Number Information
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NPI Number | 1740310549
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Entity Type | Organization
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Legal Business Name | JULIA STREET CLINIC, INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 JULIA STREET
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City | ISOLA
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State | MS
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Zip | 38754
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Country | US
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Telephone | 662-962-7923
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | ISOLA
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State | MS
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Zip | 38754-0553
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Country | US
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Telephone | 662-962-7923
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Fax | 662-962-2576
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VERNITA JAMES
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Credential |
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Telephone | 662-962-7923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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