| Fusion Of Wellness: Body, Mind, And Soul, Llc. | |
|
712 N Main St Georgetown IL 61846-1440 | |
| (217) 274-6966 | |
| Not Available |
| Full Name | Fusion Of Wellness: Body, Mind, And Soul, Llc. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 712 N Main St, Georgetown, Illinois |
| Authorized Official Name and Position | Fabienne Nadeen Witherspoon (OWNER/NURSE PRACTITIONER) |
| Authorized Official Contact | 2172746966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fusion Of Wellness: Body, Mind, And Soul, Llc. 712 N Main St Georgetown IL 61846-1440 Ph: (217) 274-6966 | Fusion Of Wellness: Body, Mind, And Soul, Llc. 712 N Main St Georgetown IL 61846-1440 Ph: (217) 274-6966 |
| NPI Number | 1922503465 |
|---|---|
| Provider Enumeration Date | 03/27/2018 |
| Last Update Date | 05/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922503465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 209009867 (Illinois) | Primary |
Family Practice Medical Center Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 302 N Main St, Georgetown, IL 61846 Phone: 217-662-2282 Fax: 217-662-6946 |