Provider Demographics
NPI:1013163690
Name:WELLNESS CLINIC AND FAMILY CARE PLLC
Entity Type:Organization
Organization Name:WELLNESS CLINIC AND FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:HAZARD
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-983-2328
Mailing Address - Street 1:2410 ENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-3945
Mailing Address - Country:US
Mailing Address - Phone:731-983-2328
Mailing Address - Fax:
Practice Address - Street 1:21 MERIDIAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-5900
Practice Address - Country:US
Practice Address - Phone:731-256-0526
Practice Address - Fax:731-256-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024799261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care