Healthcare Provider Details

I. General information

NPI: 1235952045
Provider Name (Legal Business Name): MEET AT THE WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W PEACE ST
CANTON MS
39046-4325
US

IV. Provider business mailing address

402 AUDUBON WOODS
CANTON MS
39046-8883
US

V. Phone/Fax

Practice location:
  • Phone: 601-691-2277
  • Fax:
Mailing address:
  • Phone: 470-496-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON TROY BROWN JR.
Title or Position: OWNER
Credential:
Phone: 470-496-7066