Organization
WELLNESS CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAVIRA V SIDHU M.D. (PRESIDENT)
(662) 892-5000
Entity
Organization
Contact information
Practice address
5740 GETWELL RD, BLDG 4C, SOUTHAVEN, MS 38672-6346
(662) 892-5000
(662) 892-5002
Mailing address
PO BOX 2024, OLIVE BRANCH, MS 38654-2209
(662) 892-5000
(662) 892-5002
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
MD000025744
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120361
—
MS
05
—
3725205
—
TN
05
—
F95674
—
MS
Enumeration date
04/17/2007
Last updated
02/15/2011
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