Provider Demographics
NPI:1164085809
Name:HANDS OF PURPOSE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:HANDS OF PURPOSE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COEVA
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-324-3057
Mailing Address - Street 1:220 W GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3222
Mailing Address - Country:US
Mailing Address - Phone:601-324-3057
Mailing Address - Fax:601-980-0360
Practice Address - Street 1:220 W GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3222
Practice Address - Country:US
Practice Address - Phone:601-324-3057
Practice Address - Fax:601-980-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS87726OtherUNITED HEALTHCARE