Provider Demographics
NPI:1164855672
Name:TOTAL HEALTH & WELLNESS OBGYN LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH & WELLNESS OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-384-8780
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-384-8780
Mailing Address - Fax:937-384-4876
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-384-8780
Practice Address - Fax:937-384-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071571207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2238322Medicaid
OH2238322Medicaid