Healthcare Provider Details

I. General information

NPI: 1245671114
Provider Name (Legal Business Name): GENESIS WEIGHT AND AGE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 CRESTMOOR RD STE 204
NASHVILLE TN
37215-2037
US

IV. Provider business mailing address

2207 CRESTMOOR RD STE 204
NASHVILLE TN
37215-2037
US

V. Phone/Fax

Practice location:
  • Phone: 615-442-8586
  • Fax: 615-442-8587
Mailing address:
  • Phone: 615-442-8586
  • Fax: 615-442-8587

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: BRENT MESSER
Title or Position: CO-OWNER
Credential:
Phone: 615-442-8586