Individual
JOSEPH M FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA, MHSA, ATC
Contact information
Practice address
1134 N MAIN ST STE 3100, BELLEFONTAINE, OH 43311-0017
(937) 651-6441
(937) 651-6442
Mailing address
1134 N MAIN ST STE 3100, BELLEFONTAINE, OH 43311
(937) 651-6441
(937) 651-6442
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2601001048
MI
363A00000X
Physician Assistant
Primary
50.006182RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0371852
—
OH
Enumeration date
05/03/2015
Last updated
06/10/2024
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