Provider Demographics
NPI:1104665041
Name:AN MEDI-ZEN, PLLC
Entity type:Organization
Organization Name:AN MEDI-ZEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, DOCTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-EBY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DCM
Authorized Official - Phone:662-877-4555
Mailing Address - Street 1:2130A PEARMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:BOYLE
Mailing Address - State:MS
Mailing Address - Zip Code:38730-9770
Mailing Address - Country:US
Mailing Address - Phone:662-877-5555
Mailing Address - Fax:
Practice Address - Street 1:124 S. BROADWAY STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701
Practice Address - Country:US
Practice Address - Phone:662-877-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty