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General NPI Number Information
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NPI Number | 1821930777
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Entity Type | Organization
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Legal Business Name | WELLNESS SOURCE LLC
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 4301 GARDEN CITY DR STE 304
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City | HYATTSVILLE
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State | MD
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Zip | 20785-6105
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Country | US
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Telephone | 301-235-0060
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Fax | 240-324-7720
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Provider Business Mailing Address
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Address Line | 4301 GARDEN CITY DR STE 304
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City | HYATTSVILLE
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State | MD
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Zip | 20785-6105
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Country | US
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Telephone |
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Fax | 240-324-7720
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARSHALEE GEORGE
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Credential |
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Telephone | 301-235-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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