Provider Demographics
NPI:1376125880
Name:AUVAN CLINIC-HEALTH AND WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:AUVAN CLINIC-HEALTH AND WELLNESS GROUP LLC
Other - Org Name:AUVAN CLINIC-HEALTH AND WELLNESS GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:678-733-1998
Mailing Address - Street 1:4270 TAMIAMI TRL E STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6887
Mailing Address - Country:US
Mailing Address - Phone:239-799-7219
Mailing Address - Fax:239-799-7209
Practice Address - Street 1:4270 TAMIAMI TRL E STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6887
Practice Address - Country:US
Practice Address - Phone:239-799-7219
Practice Address - Fax:239-799-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care