Provider Demographics
NPI:1558572297
Name:CENTER FOR WELLNESS, PA
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:SPEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-334-8447
Mailing Address - Street 1:1258 MANN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5547
Mailing Address - Country:US
Mailing Address - Phone:704-847-2022
Mailing Address - Fax:704-847-1830
Practice Address - Street 1:1258 MANN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5547
Practice Address - Country:US
Practice Address - Phone:704-847-2022
Practice Address - Fax:704-847-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty