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Organization
4D HEALTHCARE, LLC
Active
Organization
4D HEALTHCARE, LLC
Active
Other names
4D Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANYA S COCKRELL FNP-BC, PMHNP-BC (OWNER/OPERATOR)
(662) 630-5001
Entity
Organization
Contact information
Practice address
1324 MILITARY RD, COLUMBUS, MS 39701-3616
(662) 630-5001
Mailing address
1324 MILITARY RD, COLUMBUS, MS 39701-3616
(662) 630-5001
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
Other
Enumeration date
02/14/2023
Last updated
04/25/2025
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