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General NPI Number Information
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NPI Number | 1740780865
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Entity Type | Organization
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Legal Business Name | GREATER TOMORROW WELLNESS, LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 1097 W LOCUST ST
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City | WILMINGTON
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State | OH
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Zip | 45177
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Country | US
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Telephone | 937-556-6083
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Fax |
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Provider Business Mailing Address
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Address Line | 1097 W LOCUST ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CARRIE FAIRCHILD
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Credential | PA-C
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Telephone | 937-725-5754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.0034
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License Number State | OH
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