# XCEPTIONAL HEALTH & WELLNESS, PLLC.

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

## Provider details

- **NPI number:** 1770857443
- **Authorized official:** MRS. TRACEY F PETRIDES MD (OWNER/MD)
- **Authorized official phone:** (662) 510-6507

## Contact information

- **Practice address:** 5779 GETWELL RD, BLDG. D, SUITE 3, SOUTHAVEN, MS 38672-6347
- **Practice address phone:** (662) 510-6507
- **Practice address fax:** (662) 510-6508
- **Mailing address:** 5779 GETWELL RD, BLDG. D, SUITE 3, SOUTHAVEN, MS 38672-6347
- **Mailing address phone:** (662) 510-6507
- **Mailing address fax:** (662) 510-6508

## Taxonomy

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

## Other

- **Enumeration date:** 02/28/2012
- **Last updated:** 02/28/2012