Healthcare Provider Details

I. General information

NPI: 1164394417
Provider Name (Legal Business Name): EAST TEXAS CENTER FOR METABOLIC WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NORTH ST STE 100
NACOGDOCHES TX
75961-4010
US

IV. Provider business mailing address

1515 COUNTY ROAD 331
NACOGDOCHES TX
75961-0401
US

V. Phone/Fax

Practice location:
  • Phone: 936-244-8114
  • Fax:
Mailing address:
  • Phone: 214-680-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTY GILLIAM FRENCH
Title or Position: PRESIDENT
Credential: NONE
Phone: 214-680-6993