Provider Demographics
NPI:1073563995
Name:ADVANCED WELLNESS SYSTEMS, LLC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-331-1973
Mailing Address - Street 1:176 THOMPSON LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2448
Mailing Address - Country:US
Mailing Address - Phone:615-331-1973
Mailing Address - Fax:615-331-1545
Practice Address - Street 1:176 THOMPSON LN
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2448
Practice Address - Country:US
Practice Address - Phone:615-331-1973
Practice Address - Fax:615-331-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP57469Medicare UPIN
TNB04155Medicare UPIN