Healthcare Provider Details

I. General information

NPI: 1245651983
Provider Name (Legal Business Name): HEALTHY WEIGHT 4 ME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2013
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 DAUPHIN ST 3B
MOBILE AL
36608-1771
US

IV. Provider business mailing address

3715 DAUPHIN ST 3B
MOBILE AL
36608-1771
US

V. Phone/Fax

Practice location:
  • Phone: 251-706-1880
  • Fax:
Mailing address:
  • Phone: 251-706-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number4527
License Number StateAL

VIII. Authorized Official

Name: DR. RUTH SHIELDS
Title or Position: MEMBER
Credential: M.D.
Phone: 251-533-0224