Organization
FAMILY WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BHAVNA VAIDYA TANK M.D. (OWNER)
(919) 553-5711
Entity
Organization
Contact information
Practice address
2076 NC HIGHWAY 42 W STE 230, CLAYTON, NC 27520-5303
(919) 553-5711
(919) 553-5712
Mailing address
2076 NC HIGHWAY 42 W STE 230, CLAYTON, NC 27520-5303
(919) 553-5711
(919) 553-5712
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
200400430
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CA891372V
—
NC
Enumeration date
12/30/2014
Last updated
12/30/2014
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