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General NPI Number Information
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NPI Number | 1760093215
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Entity Type | Organization
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Legal Business Name | SHRIVERS WELLNESS SOLUTIONS LTD
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 310 W UNION ST STE 101
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City | ATHENS
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State | OH
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Zip | 45701-2312
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Country | US
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Telephone | 740-447-9713
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Fax | 740-447-9205
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Provider Business Mailing Address
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Address Line | 310 W UNION ST STE 101
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City | ATHENS
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State | OH
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Zip | 45701-2312
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Country | US
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Telephone | 740-447-9713
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Fax | 740-447-9205
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL / OWNER
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Name | BEN ALAN HOLTER
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Credential |
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Telephone | 740-508-0213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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