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General NPI Number Information
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NPI Number | 1437523636
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Entity Type | Organization
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Legal Business Name | WELLNESS ASSOCIATES PLLC
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 1500 GARNER RD STE A
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City | RALEIGH
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State | NC
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Zip | 27610-6669
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Country | US
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Telephone | 919-654-7309
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Fax | 919-651-1045
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Provider Business Mailing Address
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Address Line | PO BOX 10492
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City | RALEIGH
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State | NC
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Zip | 27605-0492
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Country | US
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Telephone | 919-654-7309
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Fax | 919-651-1045
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Authorized Official
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Title or Position | OWNER/CEO
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Name | WANETT WILLIAMS-MIMS
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Credential |
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Telephone | 919-654-7309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2008-01982
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License Number State | NC
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