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General NPI Number Information
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NPI Number | 1457632440
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Entity Type | Organization
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Legal Business Name | COMMUNITY WELLNESS CLINIC, LLP
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 201 ENTERPRISE ROW SUITE 12
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City | CONROE
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State | TX
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Zip | 77301-4448
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Country | US
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Telephone | 936-760-2784
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Fax | 936-760-1950
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Provider Business Mailing Address
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Address Line | 201 ENTERPRISE ROW STE 12
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City | CONROE
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State | TX
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Zip | 77301-4448
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Country | US
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Telephone | 936-760-2784
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Fax | 936-760-1950
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Authorized Official
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Title or Position | N/A
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Name | KARLA GREGORY
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Credential |
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Telephone | 936-760-2784
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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 | J4636
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | BZ3718105
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License Number State | TX
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