Alfred Conway Porter, MBA

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Practice address

3201 Hollywood Ave
Jackson, MS 39213-6754

Phone

(601) 665-3402

NPI assigned

Oct 17, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1740756758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4358 CALIFORNIA AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 HOLLYWOOD AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392136754",
            "telephone_number": "601-665-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "ALFRED",
        "middle_name": "CONWAY",
        "name_prefix": "Mr.",
        "credential": "MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner R Poppe, MD
• Portable Medical Diagnostics
• Portable Medical Diagnostics Inc
• Portable Medical Diagnostics LLC
• Portable Medical Diagnostics LLC
• Ann Michelle Porter, NP
• David Andrew Porter, PA
• Debra L Porter, PT
• John M Porter, MD
• Mary Lauren Porter, AUD

• Assisted Living Facility (Mental Illness) in Jackson, MS
• Providers in Jackson, MS by specialty
• Assisted Living Facility (Mental Illness) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.