Healthcare Provider Details

I. General information

NPI: 1760093215
Provider Name (Legal Business Name): SHRIVERS WELLNESS SOLUTIONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W UNION ST STE 101
ATHENS OH
45701-2312
US

IV. Provider business mailing address

310 W UNION ST STE 101
ATHENS OH
45701-2312
US

V. Phone/Fax

Practice location:
  • Phone: 740-447-9713
  • Fax: 740-447-9205
Mailing address:
  • Phone: 740-447-9713
  • Fax: 740-447-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN ALAN HOLTER
Title or Position: AUTHORIZED OFFICIAL / OWNER
Credential:
Phone: 740-508-0213