| Organization Name: | MOSS POINT FOOT CLINIC, LLC |
| NPI Number: | 1285827071 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWIN ESSIEN (OWNER) |
| Mailing Address: | 4316 Mcinnis Ave Moss Point |
| State: | MS US |
| Postal Code: | 395632812 |
| Phone Number: | 2284742606 |
| Fax Number: | 2284742606 |
| NPI Enumeration Date: | 08/24/2007 |
| NPI Last Update Date: | 02/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |