MEDICARE: PATH TO FREEDOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1710782685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH TO FREEDOM

Provider Business Mailing Address
First Line	:	148 STEEP HOLW
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-7004
Country	:	US
Telephone Number	:	601-316-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 BROADWAY DR STE 5
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-5074
Country	:	US
Telephone Number	:	601-202-0847
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	JERICA FOXWORTH
Credential	:	NP
Telephone Number	:	601-202-0847

Provider Enumeration Date	:	02/15/2025
Last Update Date	:	02/19/2025

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Directions to “PATH TO FREEDOM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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