Provider Demographics
NPI:1235715145
Name:VYVE WELLNESS WENDOVER PLLC
Entity Type:Organization
Organization Name:VYVE WELLNESS WENDOVER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:828-712-0102
Mailing Address - Street 1:1800 TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3741
Mailing Address - Country:US
Mailing Address - Phone:828-712-0102
Mailing Address - Fax:
Practice Address - Street 1:441 N WENDOVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1064
Practice Address - Country:US
Practice Address - Phone:704-362-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty