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General NPI Number Information
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NPI Number | 1336859354
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Entity Type | Organization
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Legal Business Name | HEALTHWISE WELLNESS DIRECT PLLC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 4014 OLD WARREN RD
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City | PINE BLUFF
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State | AR
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Zip | 71603-6110
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Country | US
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Telephone | 870-454-4354
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Fax | 870-228-0123
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Provider Business Mailing Address
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Address Line | 4014 OLD WARREN RD
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City | PINE BLUFF
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State | AR
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Zip | 71603-6110
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Country | US
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Telephone | 870-454-4354
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Fax | 870-228-0123
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOCHI AMAGWULA
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Credential | MD
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Telephone | 870-454-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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