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General NPI Number Information
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NPI Number | 1124470836
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Entity Type | Organization
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Legal Business Name | A HEALTHIER YOU WEIGHT LOSS CLINIC
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 10370 PARK RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28210-8508
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Country | US
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Telephone | 980-430-3524
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Fax | 980-430-3737
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Provider Business Mailing Address
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Address Line | 10370 PARK RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28210-8508
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Country | US
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Telephone | 980-430-3524
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Fax | 980-430-3737
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOHANNA T VAUGHAN-HORACE
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Credential |
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Telephone | 980-430-3524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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