Individual
MR. ALFRED CONWAY PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBA
Contact information
Practice address
3201 HOLLYWOOD AVE, JACKSON, MS 39213-6754
(601) 665-3402
Mailing address
4358 CALIFORNIA AVE, JACKSON, MS 39213-4707
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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