Provider Demographics
NPI:1912179078
Name:TJ3AM3
Entity Type:Organization
Organization Name:TJ3AM3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N. SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-638-6262
Mailing Address - Street 1:104 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-9003
Mailing Address - Country:US
Mailing Address - Phone:601-638-6262
Mailing Address - Fax:
Practice Address - Street 1:104 GREENVIEW DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-9003
Practice Address - Country:US
Practice Address - Phone:601-638-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870313251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based