Provider Demographics
NPI:1134689730
Name:DRAGFONFLY WELLNESS CENTER
Entity Type:Organization
Organization Name:DRAGFONFLY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-525-7488
Mailing Address - Street 1:216 QUAIL RUN CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5364
Mailing Address - Country:US
Mailing Address - Phone:423-525-7488
Mailing Address - Fax:423-722-3401
Practice Address - Street 1:102 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3525
Practice Address - Country:US
Practice Address - Phone:423-588-9978
Practice Address - Fax:423-722-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder