Provider Demographics
NPI:1255870952
Name:ALL-AMERICAN HEALTH AND WELLNESS, P.A.
Entity type:Organization
Organization Name:ALL-AMERICAN HEALTH AND WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-6332
Mailing Address - Street 1:3035 BOONE TRAIL EXT STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3860
Mailing Address - Country:US
Mailing Address - Phone:910-491-5736
Mailing Address - Fax:
Practice Address - Street 1:3035 BOONE TRAIL EXT STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3860
Practice Address - Country:US
Practice Address - Phone:910-491-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH18844Medicare UPIN