Organization · NPI-2

4d Healthcare, LLC

Clinic/Center, Multi-Specialty · Columbus, MS

NPI number1164129755
StatusActive
Last updated in NPPESApr 25, 2025

Details

NPI
1164129755
Entity type
Organization (NPI-2)
Legal business name
4d Healthcare, LLC
Organization subpart
No
Enumeration date
Feb 14, 2023
Certification date
Apr 25, 2025
Last updated
Apr 25, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM1300X Clinic/Center, Multi-Specialty––Yes
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––
261QP2300X Clinic/Center, Primary Care––

Other names

  • 4d Healthcare (Doing Business As)

Practice location

1324 Military Rd
Columbus, MS 39701-3616

Phone 662-630-5001

Mailing address

1324 Military Rd
Columbus, MS 39701-3616

Phone 662-630-5001

Authorized official

Tanya S Cockrell
Owner/Operator
6626305001

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