Healthcare Provider Details

I. General information

NPI: 1659774701
Provider Name (Legal Business Name): GARVEY WELLNESS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 LAKELAND DR SUITE B
JACKSON MS
39216-4610
US

IV. Provider business mailing address

766 LAKELAND DR SUITE B
JACKSON MS
39216-4610
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-2916
  • Fax: 601-366-2916
Mailing address:
  • Phone: 601-982-2916
  • Fax: 601-366-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0862
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL CHARLES GARVEY
Title or Position: OWNER
Credential: D.C.
Phone: 601-982-2916