Organization
MIND CLEAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD FAIRLY (SOLE MEMBER)
(661) 541-3284
Entity
Organization
Contact information
Practice address
246 CYPRESS AVE, HATTIESBURG, MS 39401-5170
(661) 541-3264
Mailing address
246 CYPRESS AVE, HATTIESBURG, MS 39401-5170
(661) 541-3264
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/06/2026
Last updated
08/06/2026
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