Provider Demographics
NPI:1275152696
Name:SAGE WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:SAGE WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:931-229-0552
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-0127
Mailing Address - Country:US
Mailing Address - Phone:931-229-0552
Mailing Address - Fax:
Practice Address - Street 1:14 LIBERTY SQ
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2044
Practice Address - Country:US
Practice Address - Phone:931-229-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty