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General NPI Number Information
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NPI Number | 1982126983
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Entity Type | Organization
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Legal Business Name | ALOHA PRIMARY CARE
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4402 E ALOHA DR STE 15
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3305
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Country | US
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Telephone | 228-222-5060
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Fax | 228-364-9004
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Provider Business Mailing Address
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Address Line | 4402 E ALOHA DR STE 15
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3305
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Country | US
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Telephone | 228-222-5060
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Fax | 228-364-9004
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MR. JAMES W EMBRY
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Credential | N.P.
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Telephone | 228-364-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State | MS
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