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Organization

SOUTHERN FAMILY URGENT CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMANDA R MIZELL FNP (OWNER/ NURSE PRACTITIONER)
(228) 896-7108
Entity
Organization

Contact information

Practice address
12303 HIGHWAY 49, GULFPORT, MS 39503-2780
(228) 999-9999
Mailing address
PO BOX 787, GRAND BAY, AL 36541-0787
(228) 206-6882

Taxonomy

Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03337280
MS
Enumeration date
03/02/2020
Last updated
02/14/2023
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