Provider Demographics
NPI:1407538804
Name:WELLCOMEMD CAROLINA CLINIC PLLC
Entity Type:Organization
Organization Name:WELLCOMEMD CAROLINA CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-944-1030
Mailing Address - Street 1:10001 PATTERSON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5126
Mailing Address - Country:US
Mailing Address - Phone:804-944-1030
Mailing Address - Fax:
Practice Address - Street 1:8035 PROVIDENCE RD STE 315
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8909
Practice Address - Country:US
Practice Address - Phone:704-444-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty