Healthcare Provider Details

I. General information

NPI: 1033717780
Provider Name (Legal Business Name): SEA GATE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E JACKSON BLVD STE 3B
JONESBOROUGH TN
37659-1505
US

IV. Provider business mailing address

900 E JACKSON BLVD STE 3B
JONESBOROUGH TN
37659-1505
US

V. Phone/Fax

Practice location:
  • Phone: 423-930-5205
  • Fax:
Mailing address:
  • Phone: 423-930-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name: XIUJIAO LI
Title or Position: MANAGER
Credential:
Phone: 423-930-5205