Organization
SOUTHLAND WELLNESS PLLC
Active
Other names
Southland Wellness PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSAY PACE RN (OWNER)
(901) 281-9387
Entity
Organization
Contact information
Practice address
6810 CRUMPLER BLVD STE 100, OLIVE BRANCH, MS 38654-1934
(662) 892-8728
Mailing address
6810 CRUMPLER BLVD STE 100, OLIVE BRANCH, MS 38654-1934
(662) 892-8728
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3836655
—
TN
Enumeration date
12/05/2022
Last updated
12/05/2022
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