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General NPI Number Information
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NPI Number | 1467035253
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Entity Type | Organization
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Legal Business Name | WELLTECH INTERNAL MEDICINE, PLLC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 101 MED TECH PKWY STE 406
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4000
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Country | US
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Telephone | 888-625-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 6128 OLD JONESBORO RD
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City | BRISTOL
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State | TN
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Zip | 37620-3020
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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
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Name | LESLIE SULLINS
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Credential |
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Telephone | 888-625-4813
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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 |
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License Number State |
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