Provider Demographics
NPI:1710215595
Name:WOMENS WELLNESS CENTER OF ABINGDON
Entity Type:Organization
Organization Name:WOMENS WELLNESS CENTER OF ABINGDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:MELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-451-5470
Mailing Address - Street 1:390 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-3808
Mailing Address - Country:US
Mailing Address - Phone:276-451-5470
Mailing Address - Fax:
Practice Address - Street 1:390 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-3808
Practice Address - Country:US
Practice Address - Phone:276-451-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty