Provider Demographics
NPI:1164394417
Name:EAST TEXAS CENTER FOR METABOLIC WELLNESS LLC
Entity type:Organization
Organization Name:EAST TEXAS CENTER FOR METABOLIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:GILLIAM
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:214-680-6993
Mailing Address - Street 1:1515 COUNTY ROAD 331
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-0401
Mailing Address - Country:US
Mailing Address - Phone:214-680-6993
Mailing Address - Fax:
Practice Address - Street 1:1220 NORTH ST STE 100
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4010
Practice Address - Country:US
Practice Address - Phone:936-244-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty