| Wellness Oasis Inc | |
|
1700 S Colorado St Greenville MS 38703-7275 | |
| (662) 702-3499 | |
| (662) 702-3126 |
| Full Name | Wellness Oasis Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 S Colorado St, Greenville, Mississippi |
| Authorized Official Name and Position | Michellda Bradshaw (OWNER) |
| Authorized Official Contact | 6627191912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Oasis Inc 21 Christy Dr Cleveland MS 38732-8780 Ph: (662) 719-1912 | Wellness Oasis Inc 1700 S Colorado St Greenville MS 38703-7275 Ph: (662) 702-3499 |
| NPI Number | 1720864796 |
|---|---|
| Provider Enumeration Date | 09/06/2023 |
| Last Update Date | 09/07/2023 |
| Certification Date | 09/07/2023 |
| Medicare PECOS PAC ID | 1052832755 |
|---|---|
| Medicare Enrollment ID | O20250311001397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720864796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Khaled N Abu-hamdan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356482459 PECOS PAC ID: 1456341221 Enrollment ID: I20040513001254 |
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