MEDICARE: WELLNESS CORPORATE SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	21D1088567	MD

General Provider Information

NPI Number	:	1508149667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CORPORATE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	7945 MACARTHUR BLVD STE 214
Second Line	:
City	:	CABIN JOHN
State	:	MD
Zip	:	20818-1634
Country	:	US
Telephone Number	:	301-229-7555
Fax Number	:	301-229-7054

Provider Business Practice Location Address
First Line	:	7945 MACARTHUR BLVD STE 214
Second Line	:
City	:	CABIN JOHN
State	:	MD
Zip	:	20818-1634
Country	:	US
Telephone Number	:	301-229-7555
Fax Number	:	301-229-7054

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FIONA GATHRIGHT
Credential	:
Telephone Number	:	301-229-7555

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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