# CLINTON WELLNESS CENTER LLC

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

## Provider details

- **NPI number:** 1124410410
- **Authorized official:** DR. MARCO MORAN DPH (OWNER)
- **Authorized official phone:** (318) 791-3765

## Contact information

- **Practice address:** 322 HIGHWAY 80 E, SUITE D, CLINTON, MS 39056-4726
- **Practice address phone:** (318) 791-3765
- **Practice address fax:** (877) 747-5326
- **Mailing address:** PO BOX 59294, JACKSON, MS 39284-9294
- **Mailing address phone:** (318) 791-3765
- **Mailing address fax:** (877) 747-5326

## Taxonomy

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

## Other

- **Enumeration date:** 02/24/2015
- **Last updated:** 02/24/2015