MEDICARE: ANNIE HOBSON WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114911765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNIE HOBSON WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2941 TERRY RD
Second Line	:	SUITE 13
City	:	JACKSON
State	:	MS
Zip	:	39212-3073
Country	:	US
Telephone Number	:	601-373-6419
Fax Number	:	601-373-3257

Provider Business Practice Location Address
First Line	:	2941 TERRY RD
Second Line	:	SUITE 13
City	:	JACKSON
State	:	MS
Zip	:	39212-3073
Country	:	US
Telephone Number	:	601-373-6419
Fax Number	:	601-373-3257

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. EDDIE MCFIELD SR.
Credential	:
Telephone Number	:	601-373-6419

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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