Provider Demographics
NPI:1598058885
Name:THE ULTIMATE WELLNESS GROUP
Entity Type:Organization
Organization Name:THE ULTIMATE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKILI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-429-4576
Mailing Address - Street 1:6614 STEARNS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2418
Mailing Address - Country:US
Mailing Address - Phone:832-429-4576
Mailing Address - Fax:
Practice Address - Street 1:12400 SHADOW CREEK PKWY
Practice Address - Street 2:UNIT 3306
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7347
Practice Address - Country:US
Practice Address - Phone:832-429-4576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty