=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609317692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITY HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2017
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 TENNESSEE ST
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38008-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-212-3196
-----------------------------------------------------
Fax | 731-212-3193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 TENNESSEE ST
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38008-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-212-3196
-----------------------------------------------------
Fax | 731-212-3193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | GREGARY COLEMAN BYERS
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 731-212-3196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 18850
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------