Provider Demographics
NPI:1558814798
Name:ASSURE WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:ASSURE WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PA-C
Authorized Official - Phone:866-551-6779
Mailing Address - Street 1:1157 S MILITARY HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2352
Mailing Address - Country:US
Mailing Address - Phone:866-551-6779
Mailing Address - Fax:877-404-1411
Practice Address - Street 1:1157 S MILITARY HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2352
Practice Address - Country:US
Practice Address - Phone:866-551-6779
Practice Address - Fax:877-404-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254631261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service