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General NPI Number Information
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NPI Number | 1023782406
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR WEIGHT LOSS, LLC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 107 MAIN ST W
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City | NEW ALBANY
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State | MS
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Zip | 38652-3324
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Country | US
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Telephone | 662-534-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 536 ROYAL PECAN WAY
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1734
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Country | US
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Telephone | 662-538-8009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM JOHNSON
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Credential | MD
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Telephone | 662-538-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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