Healthcare Provider Details

I. General information

NPI: 1538354642
Provider Name (Legal Business Name): WHOLISTIC MEDICAL CENTER OF STUART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SE OSCEOLA ST SUITE 102
STUART FL
34994-2149
US

IV. Provider business mailing address

55 SE OSCEOLA ST SUITE 102
STUART FL
34994-2149
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-2677
  • Fax: 772-219-4747
Mailing address:
  • Phone: 772-287-2677
  • Fax: 772-219-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES N GEORGIADES
Title or Position: MANAGER
Credential: DOM
Phone: 772-287-2677