NPIMap

Organization Active NPI

The Anti-Aging and Wellness Center

  • Health Service Clinic/Center
  • Ridgeland, MS
National Provider Identifier
1013286533
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
960070 Issued in MS
Legal business name
THE ANTI-AGING AND WELLNESS CENTER
Practice address
655 Lake Harbour Dr Ste 900
Ridgeland, MS 39157-4355
Phone
(601) 707-5171
NPI assigned
Dec 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Donald Ray Bonner, D.O.
Title
Owner
Phone
(601) 421-4808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 960070 MS Primary

Addresses

Primary practice location

655 Lake Harbour Dr Ste 900
Ridgeland, MS 39157-4355

Mailing address

311 Feather GLN
Ridgeland, MS 39157-8703
Phone (601) 421-4808

National Provider Directory

National Provider Directory
Tax ID family
Personalized Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

655 Lake Harbour Dr
Ste 900
Ridgeland, MS 39157
Phone (601) 707-5171

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1013286533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 FEATHER GLN",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578703",
            "telephone_number": "601-421-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 LAKE HARBOUR DR STE 900",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574355",
            "telephone_number": "601-707-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ANTI-AGING AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-29",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-421-4808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MS",
            "license": "960070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.