Organization
MINORITY AIDS SUPPORT SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN ELLIS-WILSON MS (MANAGER/AUTHORIZED OFFICIAL)
(757) 586-5243
Entity
Organization
Contact information
Practice address
247 28TH ST STE 100, NEWPORT NEWS, VA 23607-3907
(757) 586-5243
Mailing address
2715 HUNTINGTON AVE, NEWPORT NEWS, VA 23607-3913
(757) 240-4363
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
06/01/2023
Last updated
12/21/2023
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