Provider Demographics
NPI:1053050591
Name:DEFINING WELLNESS MEDICAL CENTER
Entity Type:Organization
Organization Name:DEFINING WELLNESS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-261-8405
Mailing Address - Street 1:3949 HIGHWAY 43 N
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7240
Mailing Address - Country:US
Mailing Address - Phone:754-261-8405
Mailing Address - Fax:
Practice Address - Street 1:411 HANOVER CIR STE 100
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8814
Practice Address - Country:US
Practice Address - Phone:855-761-1582
Practice Address - Fax:769-241-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty