Provider Demographics
NPI:1124465604
Name:GR WELLNESS, LLC
Entity type:Organization
Organization Name:GR WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-220-1770
Mailing Address - Street 1:2550 W ARROWOOD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6658
Mailing Address - Country:US
Mailing Address - Phone:704-220-1770
Mailing Address - Fax:704-886-1883
Practice Address - Street 1:2550 W ARROWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6658
Practice Address - Country:US
Practice Address - Phone:704-220-1770
Practice Address - Fax:704-886-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201300747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty