Provider Demographics
NPI:1184241812
Name:MOSS POINT VISIONARY CIRCLE INC
Entity type:Organization
Organization Name:MOSS POINT VISIONARY CIRCLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-345-1903
Mailing Address - Street 1:4425 GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-3707
Mailing Address - Country:US
Mailing Address - Phone:601-345-1903
Mailing Address - Fax:
Practice Address - Street 1:4425 GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-3707
Practice Address - Country:US
Practice Address - Phone:601-345-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service