Organization
THRIVE ESSENTIAL WELLNESS, INC.
Active
Organization
THRIVE ESSENTIAL WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG D TALLENT PA-C (PA-C, VICE PRESIDENT)
(843) 251-6688
Entity
Organization
Contact information
Practice address
1511 9TH AVE STE A, CONWAY, SC 29526-4126
(843) 488-1894
(843) 488-2786
Mailing address
1511 9TH AVE STE A, CONWAY, SC 29526-4126
(843) 488-1894
(843) 488-2786
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245535574
BC/BS
SC
05
—
1245535574
—
SC
01
—
1942532023
BC/BS
SC
05
—
1942532023
—
SC
01
—
1982716585
BC/BS
SC
05
—
1982716585
—
SC
01
—
1982716586
BC/BS
SC
Enumeration date
07/05/2018
Last updated
07/05/2018
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