Healthcare Provider Details

I. General information

NPI: 1932971801
Provider Name (Legal Business Name): FLUID AESTHETICS & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 HODGSON MEMORIAL DRIVE SUITE E12
SAVANNAH GA
31406
US

IV. Provider business mailing address

5710 OGEECHEE ROAD SUITE 200 BOX 310
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-268-0002
  • Fax: 888-494-4209
Mailing address:
  • Phone: 912-268-0002
  • Fax: 888-494-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DAVIS
Title or Position: CREDENTIALING SPECIALISTS
Credential:
Phone: 912-373-4385