Provider Demographics
NPI:1649053539
Name:AWAKENING WELLNESS CLINIC LLP
Entity type:Organization
Organization Name:AWAKENING WELLNESS CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BINION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-232-4114
Mailing Address - Street 1:165 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2265
Mailing Address - Country:US
Mailing Address - Phone:901-232-4114
Mailing Address - Fax:662-932-4230
Practice Address - Street 1:165 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2265
Practice Address - Country:US
Practice Address - Phone:901-232-4114
Practice Address - Fax:662-932-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory