Healthcare Provider Details

I. General information

NPI: 1518270115
Provider Name (Legal Business Name): SELF CENTERED WEIGHT LOSS AND WELLNESS OF MURFREESBORO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 LEAF AVE STE 102
MURFREESBORO TN
37130-2642
US

IV. Provider business mailing address

1211 LEAF AVE STE 102
MURFREESBORO TN
37130-2642
US

V. Phone/Fax

Practice location:
  • Phone: 615-849-7777
  • Fax: 615-849-7753
Mailing address:
  • Phone: 615-849-7777
  • Fax: 615-849-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA J SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-849-7777