Healthcare Provider Details

I. General information

NPI: 1770830804
Provider Name (Legal Business Name): GENESIS HEALTH AND WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W DUE WEST AVE SUITE 105
MADISON TN
37115-4431
US

IV. Provider business mailing address

607 W DUE WEST AVE SUITE 105
MADISON TN
37115-4431
US

V. Phone/Fax

Practice location:
  • Phone: 615-891-4903
  • Fax: 615-864-8671
Mailing address:
  • Phone: 615-891-4903
  • Fax: 615-864-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALLISION PATRICE PUCKETT
Title or Position: OWNER
Credential: MD
Phone: 615-585-9305