Provider Demographics
NPI:1740012467
Name:MEDI PEDI WELLNESS EMPIRE
Entity type:Organization
Organization Name:MEDI PEDI WELLNESS EMPIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-654-4554
Mailing Address - Street 1:7710 E BRAINERD RD APT 403
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5916
Mailing Address - Country:US
Mailing Address - Phone:423-654-4554
Mailing Address - Fax:
Practice Address - Street 1:7429 E BRAINERD RD STE 121
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4873
Practice Address - Country:US
Practice Address - Phone:423-654-4554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty