Provider Demographics
NPI:1467201178
Name:INTEGRATIVE HEALTH & WELLNESS OF HENRY COUNTY, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH & WELLNESS OF HENRY COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-363-1209
Mailing Address - Street 1:212 MEMORIAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5416
Mailing Address - Country:US
Mailing Address - Phone:731-641-0605
Mailing Address - Fax:731-641-4525
Practice Address - Street 1:212 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5416
Practice Address - Country:US
Practice Address - Phone:731-641-0605
Practice Address - Fax:731-641-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ094035Medicaid