Organization
GENESIS HEALTH AND WELLNESS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALLISION PATRICE PUCKETT MD (OWNER)
(615) 585-9305
Entity
Organization
Contact information
Practice address
607 W DUE WEST AVE, SUITE 105, MADISON, TN 37115-4431
(615) 891-4903
(615) 864-8671
Mailing address
607 W DUE WEST AVE, SUITE 105, MADISON, TN 37115-4431
(615) 891-4903
(615) 864-8671
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1530899
—
TN
Enumeration date
08/08/2012
Last updated
05/16/2013
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