Provider Demographics
NPI:1447924535
Name:HEART & SOUL WELLNESS LLC
Entity type:Organization
Organization Name:HEART & SOUL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONDI
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-500-9207
Mailing Address - Street 1:784 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0135
Mailing Address - Country:US
Mailing Address - Phone:912-500-9207
Mailing Address - Fax:432-200-9558
Practice Address - Street 1:5 LATIMER ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6111
Practice Address - Country:US
Practice Address - Phone:912-500-9207
Practice Address - Fax:432-200-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)