Provider Demographics
NPI:1457051591
Name:RAPHA WELLNESS AND PRIMARY CARE, LLC
Entity type:Organization
Organization Name:RAPHA WELLNESS AND PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYROLL AND ACCOUNTS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-992-9790
Mailing Address - Street 1:148 DAUGHDRILL STA
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8406
Mailing Address - Country:US
Mailing Address - Phone:601-992-9790
Mailing Address - Fax:601-992-9796
Practice Address - Street 1:148 DAUGHDRILL STA
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8406
Practice Address - Country:US
Practice Address - Phone:601-992-9790
Practice Address - Fax:601-992-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care