MORIAH NPI 1003958117

NPI Information

MORIAH is a specialist in Gulfport, MS. The provider is 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. MORIAH NPI is 1003958117. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dr. Tim Jackson.

The provider's business location address is:

12080 NEW ORLEANS AVE N
GULFPORT, MS
ZIP 39503-180
Phone: (228) 832-9933
Fax: (228) 832-9916

The provider's authorized official is Timothy D Jackson .
The authorized official title is Owner and has the following contact phone number (228) 832-9933.

The enumeration date for this NPI number is 2/13/2007 and was last updated on 8/22/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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