Healthcare Provider Details

I. General information

NPI: 1053144188
Provider Name (Legal Business Name): NEW YOU WEIGHT LOSS & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 REMBERT C DENNIS BLVD
MONCKS CORNER SC
29461-3943
US

IV. Provider business mailing address

206 REMBERT C DENNIS BLVD
MONCKS CORNER SC
29461-3943
US

V. Phone/Fax

Practice location:
  • Phone: 843-934-9649
  • Fax: 843-352-4831
Mailing address:
  • Phone: 843-934-9649
  • Fax: 843-352-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DALE BRINSON
Title or Position: PRESIDENT
Credential: FNP-C
Phone: 843-761-8905