Healthcare Provider Details

I. General information

NPI: 1649790437
Provider Name (Legal Business Name): MAYS MEDICAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 GOODMAN RD E STE 128
SOUTHAVEN MS
38672-6494
US

IV. Provider business mailing address

3964 GOODMAN RD E STE 128
SOUTHAVEN MS
38672-6494
US

V. Phone/Fax

Practice location:
  • Phone: 662-655-0456
  • Fax: 662-655-0457
Mailing address:
  • Phone: 662-655-0456
  • Fax: 662-655-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACEY L. MAYS
Title or Position: FNP
Credential: FNP
Phone: 662-655-0456