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General NPI Number Information
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NPI Number | 1952687626
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Entity Type | Organization
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Legal Business Name | ADVANCED WELLNESS SOLUTIONS, PC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 101 WESTMEAD RD
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City | UNION
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State | SC
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Zip | 29379-8886
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Country | US
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Telephone | 864-426-5323
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Fax |
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Provider Business Mailing Address
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Address Line | 101 WESTMEAD RD
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City | UNION
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State | SC
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Zip | 29379-8886
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Country | US
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Telephone | 864-426-5323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN LUTZ
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Credential | MD
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Telephone | 864-426-5323
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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 | 30256
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License Number State | SC
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