Provider Demographics
NPI:1043045768
Name:HAVILAH MEDICAL AND WELLNESS LLC
Entity type:Organization
Organization Name:HAVILAH MEDICAL AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-457-1668
Mailing Address - Street 1:24303 OASIS BEND DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 COBIA DR STE 701
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6892
Practice Address - Country:US
Practice Address - Phone:317-457-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty