Healthcare Provider Details

I. General information

NPI: 1790310373
Provider Name (Legal Business Name): AMA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 S HOUSTON LAKE RD
WARNER ROBINS GA
31088-2723
US

IV. Provider business mailing address

1282 S HOUSTON LAKE RD
WARNER ROBINS GA
31088-2723
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-4010
  • Fax:
Mailing address:
  • Phone: 478-922-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANILKUMAR V PILLAI
Title or Position: OWNER
Credential: MD
Phone: 478-922-4010