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General NPI Number Information
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NPI Number | 1013263151
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Entity Type | Organization
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Legal Business Name | WELLNESS PSYCHIATRY GROUP, P.C.
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 249 WILLIAMSON RD SUITE 102
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City | MOORESVILLE
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State | NC
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Zip | 28117-8195
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Country | US
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Telephone | 704-912-7037
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Fax |
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Provider Business Mailing Address
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Address Line | 249 WILLIAMSON RD SUITE 102
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City | MOORESVILLE
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State | NC
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Zip | 28117-8195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. UMANG SHAH
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Credential | M.D.,
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Telephone | 704-912-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1267930
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License Number State | NC
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