Provider Demographics
NPI:1194267484
Name:WELLNESS AND PREVENTATIVE CARE CENTERS LLC
Entity type:Organization
Organization Name:WELLNESS AND PREVENTATIVE CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-428-1715
Mailing Address - Street 1:PO BOX 3003
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20188-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-648-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty