# MINORITY AIDS SUPPORT SERVICES INC

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

## Provider details

- **NPI number:** 1619660883
- **Authorized official:** GWENDOLYN ELLIS-WILSON MS (MANAGER/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (757) 586-5243

## Contact information

- **Practice address:** 247 28TH ST STE 100, NEWPORT NEWS, VA 23607-3907
- **Practice address phone:** (757) 586-5243
- **Mailing address:** 2715 HUNTINGTON AVE, NEWPORT NEWS, VA 23607-3913
- **Mailing address phone:** (757) 240-4363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2023
- **Last updated:** 12/21/2023