Emmanuel Ridge Comm Phcy
Legal Business Name
Emmanuel Ridge Comm Phcy
NPI Number
1073524583
NPI Type
Organization
Enumeration Date
08/10/2006
Specialties
(Taxonomies)Code
3336C0003X
3336I0012X
3336L0003X
Primary Taxonomy
No
No
No
Licenses
State
Mississippi
License Number
06939011
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 1522
2073 HIGHWAY 49 S
City
Florence
Florence
State
MS
MS
Postal Code
39073-1522
39073-9422
Country
US
US
Telephone Number
N/A
(601) 845-3544
Authorized Official
Name
Beatrice Ezem
Title or Position
PRESIDENT
Telephone Number
(601) 927-9839
Identifiers
Identifier
2586622
Identifier State
Unknown
Identifier Issuer
OTHER ID NUMBER-COMMERCIAL NUMBER
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/22/2020