Provider Demographics
NPI:1508293192
Name:NASHVILLE WELLNESS CLINIC & MEDI-SPA PA
Entity Type:Organization
Organization Name:NASHVILLE WELLNESS CLINIC & MEDI-SPA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-747-2089
Mailing Address - Street 1:117 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1327
Mailing Address - Country:US
Mailing Address - Phone:252-459-5544
Mailing Address - Fax:252-459-9300
Practice Address - Street 1:117 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1327
Practice Address - Country:US
Practice Address - Phone:252-459-5544
Practice Address - Fax:252-459-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty