Provider Demographics
NPI:1982126983
Name:ALOHA PRIMARY CARE
Entity Type:Organization
Organization Name:ALOHA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:228-364-9001
Mailing Address - Street 1:4402 E ALOHA DR STE 15
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3305
Mailing Address - Country:US
Mailing Address - Phone:228-222-5060
Mailing Address - Fax:228-364-9004
Practice Address - Street 1:4402 E ALOHA DR STE 15
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3305
Practice Address - Country:US
Practice Address - Phone:228-222-5060
Practice Address - Fax:228-364-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty