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General NPI Number Information
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NPI Number | 1114724234
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Entity Type | Organization
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Legal Business Name | STAR WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 101 FORREST CROSSING BLVD STE 105B
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City | FRANKLIN
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State | TN
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Zip | 37064-5402
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Country | US
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Telephone | 865-383-0522
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FORREST CROSSING BLVD STE 105B
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City | FRANKLIN
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State | TN
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Zip | 37064-5402
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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 | MANAGER
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Name | ALEXANDER WILLIAMS
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Credential |
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Telephone | 865-383-0522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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