Healthcare Provider Details

I. General information

NPI: 1871185405
Provider Name (Legal Business Name): WELLNESS AMBULATORY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 BERNARD AVE
KNOXVILLE TN
37921-6253
US

IV. Provider business mailing address

5001 SPRING VALLEY ROAD SUITE 600 EAST
DALLAS TX
75244
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-0161
  • Fax: 865-521-7920
Mailing address:
  • Phone: 214-365-6100
  • Fax: 214-365-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEMECE MICHELLE GASAWAY
Title or Position: DIRECTOR OF LICENSING
Credential: MSW, LMSW
Phone: 214-365-6126