Basic Information
| Provider Information | |||||||||
| NPI: | 1467759860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERMANTOWN WELLNESS & PREVENTIVE MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 EXETER RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016841322 | ||||||||
| FaxNumber: | 9016826368 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 EXETER RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016841322 | ||||||||
| FaxNumber: | 9016826368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | POSEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | EVANS | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9013372410 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.