Provider Demographics
NPI:1144037532
Name:AMANDLA WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:AMANDLA WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-708-0273
Mailing Address - Street 1:850 S 21ST ST STE M
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4846
Mailing Address - Country:US
Mailing Address - Phone:772-708-0273
Mailing Address - Fax:866-519-0540
Practice Address - Street 1:850 S 21ST ST STE M
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4846
Practice Address - Country:US
Practice Address - Phone:772-708-0273
Practice Address - Fax:866-519-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care