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General NPI Number Information
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NPI Number | 1053050591
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Entity Type | Organization
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Legal Business Name | DEFINING WELLNESS MEDICAL CENTER
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 411 HANOVER CIR STE 100
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City | RIDGELAND
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State | MS
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Zip | 39157-8814
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Country | US
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Telephone | 855-761-1582
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Fax | 769-241-2605
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Provider Business Mailing Address
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Address Line | 3949 HIGHWAY 43 N
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City | BRANDON
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State | MS
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Zip | 39047-7240
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Country | US
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Telephone | 754-261-8405
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | SONYA MUKHERJEE
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Credential |
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Telephone | 754-261-8405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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