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General NPI Number Information
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NPI Number | 1871829929
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Entity Type | Organization
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Legal Business Name | ADELINE AFTER-HOUR CARE, LLC
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 1307 ADELINE ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-5028
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Country | US
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Telephone | 601-336-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 ADELINE ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-5028
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Country | US
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Telephone | 601-336-7575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IKECHUKWU OKORIE
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Credential | M.D
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Telephone | 305-479-7945
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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 | 19875
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License Number State | MS
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