Provider Demographics
NPI:1104651066
Name:CURRENT WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:CURRENT WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:208-251-9985
Mailing Address - Street 1:74 CALUSA WAY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1168
Mailing Address - Country:US
Mailing Address - Phone:850-284-3801
Mailing Address - Fax:850-204-4069
Practice Address - Street 1:117 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1105
Practice Address - Country:US
Practice Address - Phone:850-284-3801
Practice Address - Fax:850-204-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care