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General NPI Number Information
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NPI Number | 1851757785
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Entity Type | Organization
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Legal Business Name | IMANI FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 4510 HANGING MOSS RD
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City | JACKSON
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State | MS
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Zip | 39206-3962
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Country | US
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Telephone | 769-257-5713
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Fax | 769-257-5715
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Provider Business Mailing Address
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Address Line | 4510 HANGING MOSS RD
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City | JACKSON
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State | MS
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Zip | 39206-3962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NKEBA I BELL
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Credential | FNP
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Telephone | 601-421-7242
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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 | R803867
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License Number State | MS
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