Provider Demographics
NPI:1477057966
Name:STRONG HEALTH & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:STRONG HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-613-1398
Mailing Address - Street 1:130 FAIRMONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4714
Mailing Address - Country:US
Mailing Address - Phone:601-348-2001
Mailing Address - Fax:844-247-2866
Practice Address - Street 1:130 FAIRMONT ST STE B
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4714
Practice Address - Country:US
Practice Address - Phone:601-473-2159
Practice Address - Fax:844-247-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00104317Medicaid