1548374432 NPI number — FAMILY DISCOUNT PHY AND WELLNESS CTR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548374432 NPI number — FAMILY DISCOUNT PHY AND WELLNESS CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY DISCOUNT PHY AND WELLNESS CTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548374432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
985 WAYNE RD APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38372-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
985 WAYNE RD APT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38372-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-925-5630
Provider Business Practice Location Address Fax Number:
731-926-1186
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TURNBOW
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
731-925-5630

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  240 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1452941 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4417045 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".