Desoto Wellness Clinic LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

DESOTO WELLNESS CLINIC LLC

Practice address

8829 Centre St Ste 100
Southaven, MS 38671-2610

Phone

(662) 934-8671

NPI assigned

Sep 16, 2021

Last updated

Sep 16, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Cedric Edwards, MDNPI 1215224563

Title

Medical Director

Phone

(662) 934-8671

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cedric Edwards, M.D.

  • Internal Medicine Physician
  • Batesville, MS
  • NPI 1215224563
  NPD Authorized official

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1750051173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 SOUTHLAKES DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389018499",
            "telephone_number": "662-934-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8829 CENTRE ST STE 100",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712610",
            "telephone_number": "662-934-8671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "662-934-8671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desoto Osteopathic
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• Desoto Therapy, Inc.
• Desoto Thyroid and Endocrinology
• Desoto Urgent Care Clinic, LLC
• Desoto Womens Care Center, PLLC
• Kayla Desutter, SLP
• Brandon Deterding, PHARM.D.
• Tyrel Detweiler, D.C.
• Mahfuz Mahin Dewan

• Addiction (Substance Use Disorder) Counselor in Southaven, MS
• Providers in Southaven, MS by specialty
• Addiction (Substance Use Disorder) Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.