Organization
IMMEDIATE FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN PERRY FNP-BC (PROVIDER)
(251) 679-1988
Entity
Organization
Contact information
Practice address
627 SARALAND BLVD S, SARALAND, AL 36571-3633
(251) 679-1988
(251) 679-9282
Mailing address
PO BOX 4674, BILOXI, MS 39535-4674
(251) 679-1988
(251) 679-9282
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R868142
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06381703
—
MS
Enumeration date
08/26/2014
Last updated
08/26/2014
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