Moriah

NPI #1003958117 in Gulfport, Mississippi

Provider Information

NPI Number: 1003958117
Entity Type: Organization
Organization Name: Moriah
Primary Specialty: Specialist
Enumeration Date: Feb 13, 2007
Last Updated: Aug 22, 2008

Practice Location

Address: 12080 NEW ORLEANS AVE N
City: Gulfport
State: Mississippi
ZIP Code: 39503-3180
Phone: (228) 832-9933

Authorized Official

Name: DR. TIMOTHY D JACKSON, M.D.
Title: OWNER
Phone: (228) 832-9933

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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