Provider Demographics
NPI:1811120512
Name:NEIGHBORHOOD HEALTHCARE PROVIDERS
Entity type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKWASI
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMPONSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-582-5805
Mailing Address - Street 1:2503 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-1073
Mailing Address - Country:US
Mailing Address - Phone:601-582-5805
Mailing Address - Fax:
Practice Address - Street 1:2503 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-1073
Practice Address - Country:US
Practice Address - Phone:601-582-5805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07580347Medicaid