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General NPI Number Information
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NPI Number | 1710215595
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Entity Type | Organization
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Legal Business Name | WOMENS WELLNESS CENTER OF ABINGDON
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 390 OAKMONT DR
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City | ABINGDON
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State | VA
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Zip | 24211-3808
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Country | US
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Telephone | 276-451-5470
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Fax |
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Provider Business Mailing Address
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Address Line | 390 OAKMONT DR
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City | ABINGDON
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State | VA
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Zip | 24211-3808
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Country | US
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Telephone | 276-451-5470
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD WILSON MELLON
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Credential | M.D
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Telephone | 276-451-5470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101242000
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License Number State | VA
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