Organization
WELLVANA MARYLAND, LLC
Active
Parent organization
WELLVANA HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLVANA HEALTH
Authorized official
KYLE WAILES (CEO)
(401) 378-7336
Entity
Organization
Contact information
Practice address
4840 CENTENNIAL BLVD STE 202, NASHVILLE, TN 37209-1792
(860) 501-7908
Mailing address
4840 CENTENNIAL BLVD STE 202, NASHVILLE, TN 37209-1792
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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