Organization Name: | MORIAH |
NPI Number: | 1003958117 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY D JACKSON (OWNER) |
Mailing Address: | 12080 New Orleans Ave N Gulfport |
State: | MS US |
Postal Code: | 395033180 |
Phone Number: | 2288329933 |
Fax Number: | 2288329916 |
NPI Enumeration Date: | 02/13/2007 |
NPI Last Update Date: | 08/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 14510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |