Healthcare Provider Details

I. General information

NPI: 1548188758
Provider Name (Legal Business Name): ASSEMBLED ESTHETICS/ ASSEMBLED MEDICAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BELLE MEADE PT STE C
FLOWOOD MS
39232-3312
US

IV. Provider business mailing address

5622 WARNER DR
BRANDON MS
39042-7555
US

V. Phone/Fax

Practice location:
  • Phone: 601-540-7874
  • Fax:
Mailing address:
  • Phone: 601-540-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY ROBERTS
Title or Position: OWNER
Credential: NP
Phone: 601-540-7874