Healthcare Provider Details

I. General information

NPI: 1518792373
Provider Name (Legal Business Name): THE WELL JAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 LEWIS RD
CHELSEA AL
35043
US

IV. Provider business mailing address

1116 20TH ST S # 555
BIRMINGHAM AL
35205-2612
US

V. Phone/Fax

Practice location:
  • Phone: 205-515-3010
  • Fax:
Mailing address:
  • Phone: 205-515-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBBIE H LEWIS
Title or Position: OWNER
Credential: RDN
Phone: 205-515-3010