MEDICARE: WELLNESS MEDICAL CLINIC, PLLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1700473816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS MEDICAL CLINIC, PLLC

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD STE 3-258
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-545-9376
Fax Number	:	850-999-2930

Provider Business Practice Location Address
First Line	:	1820 RIGGINS RD STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-7834
Country	:	US
Telephone Number	:	850-545-9376
Fax Number	:	850-999-2930

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ARASI THANGAVELU
Credential	:	MD
Telephone Number	:	850-545-9376

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	05/24/2021

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