Organization
DIABETES AND WELLNESS CLINIC OF THE SHOALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THADDEUS JASON BOUGHTON CRNP (OWNER)
(256) 856-4059
Entity
Organization
Contact information
Practice address
1110 E 6TH ST SUITE E, MUSCLE SHOALS, AL 35661
(256) 856-4059
Mailing address
114 CHAPPELL RD, MUSCLE SHOALS, AL 35661-3650
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/27/2019
Last updated
03/27/2019
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