Provider Demographics
NPI:1083806574
Name:HEALTH AND HEALING MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:HEALTH AND HEALING MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEROGE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, DPM
Authorized Official - Phone:901-628-6684
Mailing Address - Street 1:217 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38075-4819
Mailing Address - Country:US
Mailing Address - Phone:731-254-9001
Mailing Address - Fax:731-254-9955
Practice Address - Street 1:217 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38075-4819
Practice Address - Country:US
Practice Address - Phone:731-254-9001
Practice Address - Fax:731-254-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001690261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370122OtherMEDICARE PTAN