Provider Demographics
NPI:1154726123
Name:MD WELLNESS AND HEALTH CENTER
Entity type:Organization
Organization Name:MD WELLNESS AND HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, INTERNAL MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKINI
Authorized Official - Middle Name:SHANI GARRETT
Authorized Official - Last Name:AINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-645-6400
Mailing Address - Street 1:10518 SPOTSYLVANIA AVE,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408
Mailing Address - Country:US
Mailing Address - Phone:540-645-6400
Mailing Address - Fax:888-427-4279
Practice Address - Street 1:10518 SPOTSYLVANIA AVE,
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-645-6400
Practice Address - Fax:888-427-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
VA0101238953261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty