Healthcare Provider Details

I. General information

NPI: 1932969334
Provider Name (Legal Business Name): WEIGHT LOSS AND VITALITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 RACETRACK RD
MCDONOUGH GA
30252-1022
US

IV. Provider business mailing address

5686 FULTON INDUSTRIAL BLVD SW UNIT 43992
ATLANTA GA
30336-3216
US

V. Phone/Fax

Practice location:
  • Phone: 404-902-0821
  • Fax:
Mailing address:
  • Phone: 404-902-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY ELIZABETH BELLINGER
Title or Position: COO
Credential: NP
Phone: 140-490-2082