Basic Information
| Provider Information | |||||||||
| NPI: | 1487986535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABUNDANT HEALTH & WELLNESS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1649 | ||||||||
| Address2: | |||||||||
| City: | NEW TAZEWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378241649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706188 | ||||||||
| Practice Location | |||||||||
| Address1: | 2945 MAYNARDVILLE HWY | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | MAYNARDVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378073251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657451258 | ||||||||
| FaxNumber: | 8657451276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2010 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | SAVAGE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8657451258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.