Provider Demographics
NPI:1881756658
Name:THE FAMILY WELLNESS GROUP INC.
Entity type:Organization
Organization Name:THE FAMILY WELLNESS GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:423-253-6003
Mailing Address - Street 1:707 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385
Mailing Address - Country:US
Mailing Address - Phone:423-253-6003
Mailing Address - Fax:423-253-6888
Practice Address - Street 1:707 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TELLICO PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37385-4844
Practice Address - Country:US
Practice Address - Phone:423-253-6003
Practice Address - Fax:423-253-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4439469OtherNABP
103G734608OtherMASS IMMUNIZATION ROSTER BILLER
TN4439469OtherNABP