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General NPI Number Information
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NPI Number | 1134697071
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Entity Type | Organization
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Legal Business Name | THE LIGHTER WEIGH
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR SW STE 300
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3495
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Country | US
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Telephone | 256-429-9152
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16099
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1662
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Country | US
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Telephone | 256-429-9152
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHARMAINE BLAKE WOODE
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Credential | MD
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Telephone | 256-429-9152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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