# INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104580943
- **Authorized official:** MR. DAVID F. ROWE (OWNER, AUTHORIZED OFFICIAL)
- **Authorized official phone:** (228) 248-0561

## Contact information

- **Practice address:** 212 DRAPERTON CT, RIDGELAND, MS 39157-3905
- **Practice address phone:** (769) 300-9040
- **Practice address fax:** (769) 300-9055
- **Mailing address:** 2556 MARCIA CT, BILOXI, MS 39531-2352
- **Mailing address phone:** (228) 248-0561
- **Mailing address fax:** (228) 248-0562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2021
- **Last updated:** 10/29/2021