Line Street Medical, LLC
NPI #1821560327 in Philadelphia, Mississippi
Provider Information
- NPI Number
- 1821560327
- Entity Type
- Organization
- Organization Name
- Line Street Medical, LLC
- Primary Specialty
- Nurse Practitioner - Family
- Enumeration Date
- Dec 20, 2018
- Last Updated
- Apr 30, 2020
Practice Location
- Address
- 562 LINE ST S STE 1
- City
- Philadelphia
- State
- Mississippi
- ZIP Code
- 39350-2144
- Phone
- (601) 562-6363
Authorized Official
- Name
- LEAH DENISE PHILLIPS, FNP-C
- Title
- NURSE PRACTITIONER
- Phone
- (601) 562-6363
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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