Wellness Source LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

WELLNESS SOURCE LLC

Practice address

4301 Garden City Dr Ste 304
Hyattsville, MD 20785-6105

Phone

(301) 235-0060

NPI assigned

Mar 14, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marshalee GeorgeNPI 1952370272

Title

Medical Director

Phone

(301) 235-0060

Specialties & licenses 10

Addresses

Other names 1

• Your Wellness Sources Doing business as

Electronic endpoints 1

Tax ID family

Wellness Source LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Wellness Source LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hyattsville, MD
  • NPI 1205339413
  NPD tax ID
• Wellness Source LLC

  • Podiatrist
  • Hyattsville, MD
  • NPI 1821930777
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marshalee George, PHD, C.R.N.P., PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hyattsville, MD
  • NPI 1952370272
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1114420320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 GARDEN CITY DR STE 304",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207856105",
            "telephone_number": "301-235-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 GARDEN CITY DR STE 304",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207856105",
            "telephone_number": "301-235-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-14",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "MARSHALEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-235-0060"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@yourwellnesssources.com",
            "affiliation": "N",
            "address_1": "4301 Garden City Dr Ste 304",
            "city": "Hyattsville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207856105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Your Wellness Sources",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marquance Latoya Watson
• Peter Wawrzusin, M.D.
• Julie Ann Weaver
• Kristal Weems-Bradner, OTR/L
• Vanessa Welague-Pamela
• Wellness Source LLC
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• Wellness Source LLC
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• Registered Dietitian in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.