Healthcare Provider Details

I. General information

NPI: 1760109847
Provider Name (Legal Business Name): WELLNESS WITHIN JACKSON II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 SPRING ARBOR RD STE 300
JACKSON MI
49203-8623
US

IV. Provider business mailing address

3343 SPRING ARBOR RD STE 300
JACKSON MI
49203-8623
US

V. Phone/Fax

Practice location:
  • Phone: 517-206-3698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY FREDERICK
Title or Position: MGR
Credential: MGR
Phone: 517-206-3698