Individual
MR. JERMAINE HANFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
410 S AVALON ST, VFW DRIVE, WEST MEMPHIS, AR 72301-4183
(870) 394-9577
Mailing address
703 CALVIN AVERY DR, SUITE B, WEST MEMPHIS, AR 72301-6501
(870) 732-1878
(870) 735-5401
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201812795
—
AR
Enumeration date
05/09/2014
Last updated
05/09/2014
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