Provider Demographics
NPI:1235218546
Name:WILMINGTON WELLNESS GROUP, PA
Entity Type:Organization
Organization Name:WILMINGTON WELLNESS GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ELLINGTON
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-471-4774
Mailing Address - Street 1:1213 CULBRETH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3684
Mailing Address - Country:US
Mailing Address - Phone:910-471-4773
Mailing Address - Fax:
Practice Address - Street 1:1213 CULBRETH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3684
Practice Address - Country:US
Practice Address - Phone:910-471-4773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141FFOtherBLUE CROSS
NC5903309Medicaid
NC2050098Medicare ID - Type Unspecified
NC5903309Medicaid