Provider Demographics
NPI:1235952045
Name:MEET AT THE WELL LLC
Entity type:Organization
Organization Name:MEET AT THE WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:470-496-7066
Mailing Address - Street 1:402 AUDUBON WOODS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8883
Mailing Address - Country:US
Mailing Address - Phone:470-496-7066
Mailing Address - Fax:
Practice Address - Street 1:217 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4325
Practice Address - Country:US
Practice Address - Phone:601-691-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy