Provider Demographics
NPI:1487168696
Name:PRECISION WELLNESS GROUP
Entity type:Organization
Organization Name:PRECISION WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-873-8292
Mailing Address - Street 1:5529 PHELPS LUCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2554
Mailing Address - Country:US
Mailing Address - Phone:301-873-8292
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4868
Practice Address - Country:US
Practice Address - Phone:301-333-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty