Provider Demographics
NPI:1427563238
Name:APPALACHIANWELLNESS CLINIC INC
Entity Type:Organization
Organization Name:APPALACHIANWELLNESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:JAFARY
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:304-222-5817
Mailing Address - Street 1:56 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3684
Mailing Address - Country:US
Mailing Address - Phone:304-222-5817
Mailing Address - Fax:
Practice Address - Street 1:425 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3145
Practice Address - Country:US
Practice Address - Phone:304-222-5817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty