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General NPI Number Information
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NPI Number | 1699268672
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Entity Type | Organization
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Legal Business Name | WELLNESSCONNECT HEALTHCARE AND PREVENTIVE MEDICINE, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 2011 GALLATIN ST SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4510
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Country | US
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Telephone | 256-907-2493
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Fax | 256-281-8134
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Provider Business Mailing Address
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Address Line | 2011 GALLATIN ST SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4510
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Country | US
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Telephone | 256-907-2493
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Fax | 256-907-1726
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Authorized Official
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Title or Position | BILLING MANAGER/CREDENTIALING
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Name | JACKIE COPELAND
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Credential | CPC
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Telephone | 256-907-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD13209
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | MD13209
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00013209
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License Number State | AL
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