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General NPI Number Information
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NPI Number | 1194267484
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Entity Type | Organization
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Legal Business Name | WELLNESS AND PREVENTATIVE CARE CENTERS LLC
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 13135 LEE JACKSON MEMORIAL HWY
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City | FAIRFAX
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State | VA
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Zip | 22033-1907
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Country | US
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Telephone | 703-648-0015
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3003
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City | WARRENTON
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State | VA
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Zip | 20188-1703
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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 | OWNER OF PRACTICE
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Name | JYOTHI GADDE
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Credential | M.D.
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Telephone | 540-428-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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