NPI 1003958117

Moriah

Organisation Specialist Gulfport, MS

Practice location

Address: 12080 New Orleans Ave N, Gulfport, MS 39503-3180
Phone: (228) 832-9933
Fax: (228) 832-9916
Mailing address: PO Box 10049, Gulfport, MS 39505-0049

Authorised official

Name: Timothy D Jackson
Title: Owner
Phone: (228) 832-9933

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 14510 (MS)

Other Specialist providers in Mississippi →

Registry record

NPI: 1003958117
Entity type: Organization
NPI issued: 13 Feb 2007
Record last updated: 22 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.