Healthcare Provider Details

I. General information

NPI: 1205977584
Provider Name (Legal Business Name): WWJD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3843 MOLLER RD
INDIANAPOLIS IN
46254-2930
US

IV. Provider business mailing address

3843 MOLLER RD
INDIANAPOLIS IN
46254-2930
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-3376
  • Fax:
Mailing address:
  • Phone: 317-291-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17000937
License Number StateIN

VIII. Authorized Official

Name: MR. DOUGLAS RANDOLPH MCMILLIN
Title or Position: PRESIDENT
Credential:
Phone: 317-291-3376