| Milestone Community Development Center | |
|
1700 S Colorado St Greenville MS 38703 | |
| (662) 207-4610 | |
| (662) 743-4404 |
| Full Name | Milestone Community Development Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 S Colorado St, Greenville, Mississippi |
| Authorized Official Name and Position | Nicole Watkins (OWNER) |
| Authorized Official Contact | 6622074610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Milestone Community Development Center 1700 S Colorado St Greenville MS 38703 Ph: (662) 207-4610 | Milestone Community Development Center 1700 S Colorado St Greenville MS 38703 Ph: (662) 207-4610 |
| NPI Number | 1700546561 |
|---|---|
| Provider Enumeration Date | 12/21/2021 |
| Last Update Date | 12/21/2021 |
| Certification Date | 12/20/2021 |
| Medicare PECOS PAC ID | 8224406384 |
|---|---|
| Medicare Enrollment ID | O20221121001532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700546561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Khaled N Abu-hamdan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356482459 PECOS PAC ID: 1456341221 Enrollment ID: I20040513001254 |
| Provider Name | Valina Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447928148 PECOS PAC ID: 6608244371 Enrollment ID: I20221130002561 |
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