Healthcare Provider Details

I. General information

NPI: 1467711150
Provider Name (Legal Business Name): WILLIAMSON HEALTH & WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE SUITE 210
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

PO BOX 2080
WILLIAMSON WV
25661-2080
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 855-487-4047
Mailing address:
  • Phone: 304-236-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number1875
License Number StateWV

VIII. Authorized Official

Name: DR. CHRISTOPHER DONOVAN BECKETT
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 304-236-5902