Healthcare Provider Details

I. General information

NPI: 1003553785
Provider Name (Legal Business Name): PREVENTATIVE WELLNESS SOLUTIONS III PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PERKINS DR STE 300
CHAPEL HILL NC
27514-1786
US

IV. Provider business mailing address

509 S HYDE PARK AVE
TAMPA FL
33606-2266
US

V. Phone/Fax

Practice location:
  • Phone: 919-364-3344
  • Fax: 919-364-0137
Mailing address:
  • Phone: 813-228-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY HEALD
Title or Position: MGR
Credential:
Phone: 813-228-6334