Provider Demographics
NPI:1841654886
Name:NOVUS HEALTH AND WELLNESS
Entity type:Organization
Organization Name:NOVUS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:DYAVANAPALLI
Authorized Official - Last Name:GUDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-830-8666
Mailing Address - Street 1:4808 MUNSON ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3613
Mailing Address - Country:US
Mailing Address - Phone:330-830-8666
Mailing Address - Fax:330-832-3499
Practice Address - Street 1:4808 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-830-8666
Practice Address - Fax:330-832-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty