Provider Demographics
NPI:1598376865
Name:DEYOE WELLNESS
Entity Type:Organization
Organization Name:DEYOE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-982-7714
Mailing Address - Street 1:37 FAWN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:RABUN GAP
Mailing Address - State:GA
Mailing Address - Zip Code:30568-2825
Mailing Address - Country:US
Mailing Address - Phone:678-982-7714
Mailing Address - Fax:706-664-0421
Practice Address - Street 1:47 COMMERCE DR STE 1B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8929
Practice Address - Country:US
Practice Address - Phone:678-982-7714
Practice Address - Fax:706-664-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty