Doctor Name: | MR. ANDREW C JUSTICE |
NPI Number: | 1568610806 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CFNP |
License Number: | R850606 |
Business Practice Address: | 1495 Maple Rd Nettleton, MS - 388586026 |
Business Phone Number: | 6629639146 |
Business Fax Number: | 6629639186 |
Mailing Address: | 1495 Maple Rd, NETTLETON |
State: | MS |
Postal Code: | 388586026 |
Phone Number: | 6629639146 |
Fax Number: | 6629639186 |
NPI Enumeration Date: | 08/28/2008 |
NPI Last Update Date: | 10/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R850606 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |