Provider Demographics
NPI:1487038816
Name:CENTER FOR WELLNESS REFERENCE LAB
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS REFERENCE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIX
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-8787
Mailing Address - Street 1:204 LOWE AVE SE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4262
Mailing Address - Country:US
Mailing Address - Phone:256-533-8787
Mailing Address - Fax:256-533-8788
Practice Address - Street 1:204 LOWE AVE SE
Practice Address - Street 2:SUITE 9
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4262
Practice Address - Country:US
Practice Address - Phone:256-533-8787
Practice Address - Fax:256-533-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL4578291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory