Healthcare Provider Details

I. General information

NPI: 1881956290
Provider Name (Legal Business Name): MENS EXECUTIVE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2798 JOHN HAWKINS PKWY STE 128
HOOVER AL
35244-3108
US

IV. Provider business mailing address

1250 WATTS RD
BOWDON GA
30108-2757
US

V. Phone/Fax

Practice location:
  • Phone: 770-328-2006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1071631
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAL 24557
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAL 20705
License Number StateAL

VIII. Authorized Official

Name: MR. ROBERT CHRIS SALTER
Title or Position: NURSE PRACTITIONER
Credential: CPRN
Phone: 770-328-2006