Organization
EVOLUTIONS ON FIFTH, LLC
Active
Other names
Mississippi Mobile Vaccination Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF BOLLING (DIRECTOR)
(662) 497-0457
Entity
Organization
Contact information
Practice address
122 5TH ST N, COLUMBUS, MS 39701-4522
(662) 630-5160
Mailing address
122 5TH ST N, COLUMBUS, MS 39701-4522
(662) 630-5160
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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