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General NPI Number Information
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NPI Number | 1598376865
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Entity Type | Organization
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Legal Business Name | DEYOE WELLNESS
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 47 COMMERCE DR STE 1B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8929
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Country | US
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Telephone | 678-982-7714
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Fax | 706-664-0421
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Provider Business Mailing Address
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Address Line | 37 FAWN RIDGE TRL
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City | RABUN GAP
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State | GA
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Zip | 30568-2825
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Country | US
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Telephone | 678-982-7714
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Fax | 706-664-0421
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LORRAINE FORDHAM
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Credential |
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Telephone | 678-982-7714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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