Provider Demographics
NPI:1255623021
Name:DIABETES AND ENDOCRINE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:DIABETES AND ENDOCRINE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAIN
Authorized Official - Middle Name:ERSKIN
Authorized Official - Last Name:WOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-881-2700
Mailing Address - Street 1:PO BOX 16099
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1662
Mailing Address - Country:US
Mailing Address - Phone:256-881-2700
Mailing Address - Fax:866-966-9740
Practice Address - Street 1:1 HOSPITAL DR SW
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6455
Practice Address - Country:US
Practice Address - Phone:256-881-2700
Practice Address - Fax:866-966-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty