Basic Information
| Provider Information | |||||||||
| NPI: | 1437523636 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLNESS ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10492 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276050492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196547309 | ||||||||
| FaxNumber: | 9196511045 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 GARNER RD STE A | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276106669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196547309 | ||||||||
| FaxNumber: | 9196511045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2015 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS-MIMS | ||||||||
| AuthorizedOfficialFirstName: | WANETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9196547309 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2008-01982 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.