MEDICARE: DEYOE WELLNESS

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1598376865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEYOE WELLNESS

Provider Business Mailing Address
First Line	:	37 FAWN RIDGE TRL
Second Line	:
City	:	RABUN GAP
State	:	GA
Zip	:	30568-2825
Country	:	US
Telephone Number	:	678-982-7714
Fax Number	:	706-664-0421

Provider Business Practice Location Address
First Line	:	47 COMMERCE DR STE 1B
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-8929
Country	:	US
Telephone Number	:	678-982-7714
Fax Number	:	706-664-0421

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	LORRAINE FORDHAM
Credential	:
Telephone Number	:	678-982-7714

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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Directions to “DEYOE WELLNESS ” Practice Location

Language	Start Address	Practice Location

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