Healthcare Provider Details

I. General information

NPI: 1497064653
Provider Name (Legal Business Name): WELLNESS EVALUATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 W REX RD
MEMPHIS TN
38119-3819
US

IV. Provider business mailing address

1061 W REX RD
MEMPHIS TN
38119-3819
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-2168
  • Fax: 901-682-9998
Mailing address:
  • Phone: 901-818-2168
  • Fax: 901-682-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15498
License Number StateTN

VIII. Authorized Official

Name: DR. JERRY L SCRUGGS
Title or Position: OWNER
Credential: M.D.
Phone: 901-818-2168