Provider Demographics
NPI:1639935042
Name:TOTAL WELLNESS SPECIALIST
Entity type:Organization
Organization Name:TOTAL WELLNESS SPECIALIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-409-0258
Mailing Address - Street 1:429 E COMMERCE ST
Mailing Address - Street 2:PMB 116
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2348
Mailing Address - Country:US
Mailing Address - Phone:662-202-5410
Mailing Address - Fax:
Practice Address - Street 1:116 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2302
Practice Address - Country:US
Practice Address - Phone:662-213-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL WELLNESS SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-23
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty