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General NPI Number Information
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NPI Number | 1932980950
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Entity Type | Organization
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Legal Business Name | MIDTOWN MEDICAL AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2750 N CHURCH AVE
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City | LOUISVILLE
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State | MS
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Zip | 39339-2054
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Country | US
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Telephone | 662-446-9432
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 N CHURCH AVE
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City | LOUISVILLE
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State | MS
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Zip | 39339-2054
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Country | US
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Telephone | 662-446-9432
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | SHELBY REEVES
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Credential | NP
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Telephone | 601-941-6251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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