Provider Demographics
NPI:1821715434
Name:MEDICAL WELLNESS AND HEALTH LLC
Entity Type:Organization
Organization Name:MEDICAL WELLNESS AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-378-0600
Mailing Address - Street 1:2124 SHADOWLAKE DR BLDG O
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7441
Mailing Address - Country:US
Mailing Address - Phone:405-378-0600
Mailing Address - Fax:405-378-0668
Practice Address - Street 1:2124 SHADOWLAKE DR BLDG O
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7441
Practice Address - Country:US
Practice Address - Phone:405-378-0660
Practice Address - Fax:405-378-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK22845OtherSTATE LICENSE