Provider Demographics
NPI:1568005056
Name:VETERANS WELLNESS CENTER OF ALABAMA LLC
Entity Type:Organization
Organization Name:VETERANS WELLNESS CENTER OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, NP-C
Authorized Official - Phone:443-902-8816
Mailing Address - Street 1:PO BOX 240132
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0132
Mailing Address - Country:US
Mailing Address - Phone:443-902-8816
Mailing Address - Fax:334-323-7148
Practice Address - Street 1:4367 ATLANTA HWY STE C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3171
Practice Address - Country:US
Practice Address - Phone:443-902-8816
Practice Address - Fax:334-323-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier