Deloach, Jim Alfred

Deloach, Jim Alfred is an sole proprietor health care provider with primary practice located at 330B Highway 90 , Gautier MS 39553-5744. He recently has only one registered license in Other Service Providers / Peer Specialist, which is considered as his primary health care specialty. Deloach, Jim Alfred can be contacted via phone (228) 497-0434.

Contact Information

Primary practice address
330B Highway 90 Gautier MS 39553-5744
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X

Profile Details

NPI number 1205554656
LBN Legal business name Deloach, Jim Alfred
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 19th, 2022
Last updated Aug 19th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205554656 NPPES
Mississippi MEDICAID 00018214

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