Provider Demographics
NPI:1124585401
Name:SHOTS AND MORE WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:SHOTS AND MORE WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNAIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-5444
Mailing Address - Street 1:890 W POPLAR AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2582
Mailing Address - Country:US
Mailing Address - Phone:901-752-5444
Mailing Address - Fax:901-752-5424
Practice Address - Street 1:890 W POPLAR AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2582
Practice Address - Country:US
Practice Address - Phone:901-752-5444
Practice Address - Fax:901-752-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service