Provider Demographics
NPI:1689421919
Name:OVERBY WELLNESS LLC
Entity type:Organization
Organization Name:OVERBY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-498-4968
Mailing Address - Street 1:1650 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 BUENA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-6622
Practice Address - Country:US
Practice Address - Phone:334-498-4968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty