Organization
PROACTIVE MD MS LLC
Active
Other names
Ashley Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JODY ADDAIR (CLINICAL OPS PROJECT COORDINATOR)
(317) 556-0017
Entity
Organization
Contact information
Practice address
6543 MS-15, ECRU, MS 38841
(662) 489-2669
Mailing address
124 ALLAWOOD CT, SIMPSONVILLE, SC 29681-6207
(864) 501-0751
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/26/2024
Last updated
01/27/2025
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