Provider Demographics
NPI:1114911765
Name:ANNIE HOBSON WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ANNIE HOBSON WELLNESS CENTER LLC
Other - Org Name:MCAFEE TRANSPORT SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFIELD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-373-6419
Mailing Address - Street 1:2941 TERRY RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3073
Mailing Address - Country:US
Mailing Address - Phone:601-373-6419
Mailing Address - Fax:601-373-3257
Practice Address - Street 1:2941 TERRY RD
Practice Address - Street 2:SUITE 13
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3073
Practice Address - Country:US
Practice Address - Phone:601-373-6419
Practice Address - Fax:601-373-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07308500Medicaid
MS08108331Medicaid