Provider Demographics
NPI:1922712793
Name:PREVENTATIVE WELLNESS SOLUTIONS I PLLC
Entity Type:Organization
Organization Name:PREVENTATIVE WELLNESS SOLUTIONS I PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:4446 US HIGHWAY 220 N STE E
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9415
Mailing Address - Country:US
Mailing Address - Phone:813-228-6334
Mailing Address - Fax:
Practice Address - Street 1:112 PERKINS DR STE 300
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1786
Practice Address - Country:US
Practice Address - Phone:919-964-3344
Practice Address - Fax:919-364-0137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVENTATIVE WELLNESS SOLUTIONS I PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty