Provider Demographics
NPI:1932489374
Name:ADVANCED WELLNESS INSTITUTE PA
Entity Type:Organization
Organization Name:ADVANCED WELLNESS INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:828-894-3494
Mailing Address - Street 1:2881 E NC 108 HWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7221
Mailing Address - Country:US
Mailing Address - Phone:828-894-3494
Mailing Address - Fax:828-894-5864
Practice Address - Street 1:2881 NC 108 HWY E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7721
Practice Address - Country:US
Practice Address - Phone:828-894-3494
Practice Address - Fax:828-894-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16340Medicare UPIN
Q33514Medicare UPIN