Provider Demographics
NPI:1548766025
Name:WOODLAND WELLNESS, INC
Entity Type:Organization
Organization Name:WOODLAND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-408-0585
Mailing Address - Street 1:115 N WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1573
Mailing Address - Country:US
Mailing Address - Phone:931-723-7904
Mailing Address - Fax:
Practice Address - Street 1:115 N WOODLAND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1573
Practice Address - Country:US
Practice Address - Phone:931-723-7904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health