Provider Demographics
NPI:1790851632
Name:COMPLETE WELLNESS MEDICAL CENTER OF GREENWOOD
Entity Type:Organization
Organization Name:COMPLETE WELLNESS MEDICAL CENTER OF GREENWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-223-6500
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0984
Mailing Address - Country:US
Mailing Address - Phone:864-223-6500
Mailing Address - Fax:864-229-5489
Practice Address - Street 1:1424E 72 BY-PASS NE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-0000
Practice Address - Country:US
Practice Address - Phone:864-223-6500
Practice Address - Fax:864-229-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC864261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center