Provider Demographics
NPI:1720795206
Name:MAKING MOVES IN THE COMMUNITY, INCORPORATED
Entity Type:Organization
Organization Name:MAKING MOVES IN THE COMMUNITY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:GOUGH-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-754-3301
Mailing Address - Street 1:189 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-3146
Practice Address - Country:US
Practice Address - Phone:662-745-6638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty