Provider Demographics
NPI:1780172932
Name:901 HEALTH & WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:901 HEALTH & WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POLLYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLZE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-827-8091
Mailing Address - Street 1:364 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4114
Mailing Address - Country:US
Mailing Address - Phone:901-827-8091
Mailing Address - Fax:
Practice Address - Street 1:364 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4114
Practice Address - Country:US
Practice Address - Phone:901-827-8091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty