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General NPI Number Information
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NPI Number | 1245322395
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Entity Type | Organization
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Legal Business Name | AESCULAPIAN AESTHETIC ANTI AGING INSTITUTE, LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 6286 BRIARCREST AVE SUITE 308
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City | MEMPHIS
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State | TN
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Zip | 38120-4023
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Country | US
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Telephone | 901-259-7000
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Fax | 901-259-7033
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Provider Business Mailing Address
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Address Line | 6286 BRIARCREST AVE SUITE 308
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City | MEMPHIS
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State | TN
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Zip | 38120-4023
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Country | US
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Telephone | 901-259-7000
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Fax | 901-259-7033
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Authorized Official
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Title or Position | CHIEF MANAGER IN CHARGE
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Name | DR. JAMES M HOLBERT JR.
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Credential | M.D., PH.D.
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Telephone | 901-259-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | MD0000006966
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD0000006966
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License Number State | TN
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