Provider Demographics
NPI:1699029074
Name:RTP HEALTHY WELLNESS PLLC
Entity Type:Organization
Organization Name:RTP HEALTHY WELLNESS PLLC
Other - Org Name:LIFESTYLE MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-260-8423
Mailing Address - Street 1:1520 SUNDAY DR STE 309
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5254
Mailing Address - Country:US
Mailing Address - Phone:919-354-7077
Mailing Address - Fax:919-354-7075
Practice Address - Street 1:1520 SUNDAY DR STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5254
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:919-354-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty