| Path to Freedom LLC | |
|
228 Broadway Dr Ste 5 Hattiesburg MS 39401-5074 | |
| (601) 202-0847 | |
| Not Available |
| Full Name | Path to Freedom LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 228 Broadway Dr Ste 5, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Jerica Foxworth (PMHNP) |
| Authorized Official Contact | 6012020847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Path to Freedom LLC 148 Steep Holw Hattiesburg MS 39402-7004 Ph: (601) 316-0019 | Path to Freedom LLC 228 Broadway Dr Ste 5 Hattiesburg MS 39401-5074 Ph: (601) 202-0847 |
| NPI Number | 1710782685 |
|---|---|
| Provider Enumeration Date | 02/15/2025 |
| Last Update Date | 02/19/2025 |
| Certification Date | 02/19/2025 |
| Medicare PECOS PAC ID | 6507370608 |
|---|---|
| Medicare Enrollment ID | O20250710000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710782685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| Provider Name | Jerica Foxworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649002866 PECOS PAC ID: 7315451416 Enrollment ID: I20250710000295 |
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