Healthcare Provider Details

I. General information

NPI: 1063930824
Provider Name (Legal Business Name): HEALING HANDS WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 WOODRIDGE DR
MEMPHIS TN
38116-7811
US

IV. Provider business mailing address

3194 ESTES ST
MEMPHIS TN
38115-2903
US

V. Phone/Fax

Practice location:
  • Phone: 901-808-5172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SEANDRIA F EVANS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 901-808-5172