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General NPI Number Information
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NPI Number | 1902013584
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Entity Type | Organization
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Legal Business Name | MAGEE AFTER HOURS CLINIC PLLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 376 SIMPSON HIGHWAY 149 # A
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City | MAGEE
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State | MS
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Zip | 39111-3409
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Country | US
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Telephone | 601-849-1230
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Fax | 601-849-1890
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Provider Business Mailing Address
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Address Line | 376 SIMPSON HIGHWAY 149 # A
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City | MAGEE
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State | MS
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Zip | 39111-3409
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Country | US
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Telephone | 601-849-1230
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Fax | 601-849-1890
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHARLES PRUITT
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Credential | M.D.
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Telephone | 601-849-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA024
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License Number State | MS
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