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General NPI Number Information
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NPI Number | 1477527034
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Entity Type | Organization
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Legal Business Name | ANNISTON WELLNESS CENTER PC
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 1400 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-3827
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Country | US
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Telephone | 256-237-7990
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Fax | 256-237-8881
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Provider Business Mailing Address
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Address Line | 1400 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-3827
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Country | US
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Telephone | 256-237-7990
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Fax | 256-237-8881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VISHWANATH MUKKAMALLA REDDY
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Credential | MD
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Telephone | 256-237-7990
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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 | 24178
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License Number State | AL
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