Organization
MUMFORD TELEHEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PENNICA MUMFORD MUMFORD RN (CEO)
(912) 844-6497
Entity
Organization
Contact information
Practice address
4113 FENWICK VILLAGE DR, SAVANNAH, GA 31419-5513
(912) 844-6497
Mailing address
4113 FENWICK VILLAGE DR, SAVANNAH, GA 31419-5513
(912) 844-6497
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
RN168735
GA
251K00000X
Public Health or Welfare Agency
RN168735
GA
251S00000X
Community/Behavioral Health Agency
Primary
RN168735
GA
252Y00000X
Early Intervention Provider Agency
RN168735
GA
253Z00000X
In Home Supportive Care Agency
RN168735
GA
261QR1300X
Rural Health Clinic/Center
RN168735
GA
Other
Enumeration date
05/17/2014
Last updated
05/17/2014
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