# HEAL THYSELF LLC

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

## Provider details

- **NPI number:** 1770178162
- **Authorized official:** SHERRELL ECHOLS (MS.)
- **Authorized official phone:** (229) 539-3710

## Contact information

- **Practice address:** 3698 INNER PERIMETER RD STE 3603, VALDOSTA, GA 31602-1047
- **Practice address phone:** (229) 539-3710
- **Mailing address:** RESIDENSE ADDRESS : 147 WILLOW COVE ROAD, VALDOSTA, GA 31602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/08/2021
- **Last updated:** 03/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 11-790-2611 | — | GA |