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General NPI Number Information
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NPI Number | 1689702870
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Entity Type | Organization
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Legal Business Name | ADULT GERIATRICS OF WOOSTER, INC.
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 1761 BEALL AVE SUITE 3C
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City | WOOSTER
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State | OH
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Zip | 44691-2342
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Country | US
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Telephone | 330-345-5374
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Fax | 330-345-5814
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Provider Business Mailing Address
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Address Line | 1761 BEALL AVE SUITE 3C
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City | WOOSTER
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State | OH
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Zip | 44691-2342
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Country | US
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Telephone | 330-345-5374
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Fax | 330-345-5814
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIMBERLY I WILLIAMS
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Credential |
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Telephone | 330-345-5374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 34074032K
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License Number State | OH
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