Healthcare Provider Details

I. General information

NPI: 1598376865
Provider Name (Legal Business Name): DEYOE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 COMMERCE DR STE 1B
BLAIRSVILLE GA
30512-8929
US

IV. Provider business mailing address

37 FAWN RIDGE TRL
RABUN GAP GA
30568-2825
US

V. Phone/Fax

Practice location:
  • Phone: 678-982-7714
  • Fax: 706-664-0421
Mailing address:
  • Phone: 678-982-7714
  • Fax: 706-664-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE FORDHAM
Title or Position: PRACTICE MANAGER
Credential:
Phone: 678-982-7714