=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447761713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CELESTIAL HEALTH CREATIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2017
-----------------------------------------------------
Last Update Date | 10/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 LAKELAND CIR STE 300
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39216-5022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-326-2300
-----------------------------------------------------
Fax | 601-345-3506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 LAKELAND CIR STE 300
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39216-5022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-326-2300
-----------------------------------------------------
Fax | 601-345-3506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. KARLISHA BRITTON
-----------------------------------------------------
Credential | LMMP-CLT
-----------------------------------------------------
Telephone | 601-574-0985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 16951
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------