Phoenix Wellness LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PHOENIX WELLNESS LLC

Practice address

1040 Edgewater Corporate Pkwy Ste 106
Fort Mill, SC 29707-4526

Phone

(704) 609-7334

Fax

(855) 655-3374

NPI assigned

Oct 26, 2021

Organization subpart

No

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

Authorized official

Name

David N Smith, MDNPI 1780780031

Title

Owner

Phone

(704) 609-7334

Specialties & licenses 11

Addresses

Electronic endpoints 1

Locations

Practitioners 4

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

• David Nathaniel Smith, MD

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1780780031
  NPD Authorized official
• Tremika Rene Baldwin, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
  • NPI 1699217208
  NPD (past)
• Willie Edward Hester Jr., M.D.

  • Nephrology Physician
  • Rutherfordton, NC
  • NPI 1730354002
  NPD (past)
• Colby Edward Joyner, PA-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1013376128
  NPD (past)

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1780348789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 CHURCHILL DOWNS DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736627",
            "telephone_number": "704-609-7334",
            "fax_number": "855-655-3374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORPORATE PKWY STE 106",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297074526",
            "telephone_number": "704-609-7334",
            "fax_number": "855-655-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-609-7334",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "phoenix@pcvcare.com",
            "affiliation": "N",
            "address_1": "1040 Edgewater Corporate Pkwy Ste 106",
            "city": "Fort Mill",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297074526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shawnie Renee Perkins, MSPAS, PA-C
• Kelly A Perron, MS, LPC, LCMHC, AADC
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• Piedmont Gynecological and Obstetrical Associates

• Multi-Specialty Clinic/Center in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Multi-Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.