Heal Thyself LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

HEAL THYSELF LLC

Practice address

3698 Inner Perimeter Rd Ste 3603
Valdosta, GA 31602-1047

Phone

(229) 539-3710

NPI assigned

Mar 8, 2021

Organization subpart

No

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

Authorized official

Name

Sherrell EcholsNPI 1417540972

Title

Ms.

Phone

(229) 539-3710

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sherrell Echols

  • Family Medicine Physician
  • Valdosta, GA
  • NPI 1417540972
  NPD Authorized official

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1770178162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RESIDENSE ADDRESS : 147 WILLOW COVE ROAD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3698 INNER PERIMETER RD STE 3603",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021047",
            "telephone_number": "229-539-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAL THYSELF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "ECHOLS",
        "authorized_official_first_name": "SHERRELL",
        "authorized_official_title_or_position": "MS.",
        "authorized_official_telephone_number": "229-539-3710"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11-790-2611",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Valdosta",
            "affiliation": "N",
            "address_1": "3698 Inner Perimeter Rd Ste 3603",
            "city": "Valdosta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "316021047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charles R Hastings, LPC
• Robert Malcolm Hatton, PHARM. D.
• Kendra Paige Hawes
• Deborah O. Hayes, CST/CSFA
• Shimels Haylie
• Healing Hands Home Healthcare Services LLC
• Health Care of Berrien County
• Health Tech Innovations
• Healthsource Medical Clinic PC
• Hearing Connection LLC

• Medical Specialty Clinic/Center in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Medical Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.