Provider Demographics
NPI:1396325924
Name:WHOLISTICTELEHEALTH
Entity type:Organization
Organization Name:WHOLISTICTELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:251-607-6653
Mailing Address - Street 1:7272 THEODORE DAWES RD STE B
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-4136
Mailing Address - Country:US
Mailing Address - Phone:251-607-6653
Mailing Address - Fax:251-607-6656
Practice Address - Street 1:7272 THEODORE DAWES RD STE B
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-4136
Practice Address - Country:US
Practice Address - Phone:251-607-6653
Practice Address - Fax:251-607-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty