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General NPI Number Information
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NPI Number | 1770178162
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Entity Type | Organization
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Legal Business Name | HEAL THYSELF LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 3698 INNER PERIMETER RD STE 3603
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City | VALDOSTA
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State | GA
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Zip | 31602-1047
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Country | US
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Telephone | 229-539-3710
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Fax |
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Provider Business Mailing Address
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Address Line | RESIDENSE ADDRESS : 147 WILLOW COVE ROAD
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MS.
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Name | SHERRELL ECHOLS
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Credential |
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Telephone | 229-539-3710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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