Liberty Health & Wellness LLC- Fayetteville

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

Legal business name

LIBERTY HEALTH & WELLNESS LLC- FAYETTEVILLE

Practice address

1816 Huntsville Hwy Ste C
Fayetteville, TN 37334-3787

Phone

(931) 297-2700

NPI assigned

Jun 28, 2019

Last updated

Jul 2, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elaina Anne Manuele, RN

Title

Owner/Manager

Phone

(662) 417-5475

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1447812599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2564 LANNING RD",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384647597",
            "telephone_number": "662-417-5475",
            "fax_number": "931-231-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 HUNTSVILLE HWY STE C",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373343787",
            "telephone_number": "931-297-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTH & WELLNESS LLC- FAYETTEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "MANUELE",
        "authorized_official_first_name": "ELAINA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "662-417-5475",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Preventive Medicine) Physician in Fayetteville, TN
• Providers in Fayetteville, TN by specialty
• Addiction Medicine (Preventive Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.