Provider Demographics
NPI:1255084398
Name:CAPITAL CITY ENDOCRINE CLINIC LLC
Entity type:Organization
Organization Name:CAPITAL CITY ENDOCRINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDIFER KUM-NJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-895-0000
Mailing Address - Street 1:4755 I 55 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206
Mailing Address - Country:US
Mailing Address - Phone:601-895-0000
Mailing Address - Fax:601-895-0001
Practice Address - Street 1:4755 I 55 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5602
Practice Address - Country:US
Practice Address - Phone:601-895-0000
Practice Address - Fax:601-895-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty