Provider Demographics
NPI:1548706922
Name:A NATURAL WAY
Entity type:Organization
Organization Name:A NATURAL WAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-874-6324
Mailing Address - Street 1:6644 GARY RD STE D
Mailing Address - Street 2:P. O. BOX 720448
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9400
Mailing Address - Country:US
Mailing Address - Phone:601-874-6324
Mailing Address - Fax:
Practice Address - Street 1:6644 GARY RD
Practice Address - Street 2:SUITE D
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9400
Practice Address - Country:US
Practice Address - Phone:601-874-6324
Practice Address - Fax:769-572-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1013384577OtherMAGNOLIA
MS1013384577OtherUNITED HEALTHCARE
MS1013384577Medicaid
MS1013384577OtherBLUE CROSS BLUE SHIELD
MS1013384577Medicare PIN
MS1013384577OtherBLUE CROSS BLUE SHIELD
MS1013384577OtherUNITED HEALTHCARE
MS1013384577Medicare UPIN