Provider Demographics
NPI:1225673395
Name:THE TRANSFORMATION DOCTOR, LLC DBA WELLNESSMD
Entity Type:Organization
Organization Name:THE TRANSFORMATION DOCTOR, LLC DBA WELLNESSMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-221-7212
Mailing Address - Street 1:3680 S HOUSTON LEVEE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9151
Mailing Address - Country:US
Mailing Address - Phone:901-221-7212
Mailing Address - Fax:901-221-7217
Practice Address - Street 1:3680 S HOUSTON LEVEE RD STE 104
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9151
Practice Address - Country:US
Practice Address - Phone:901-221-7212
Practice Address - Fax:901-221-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center