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General NPI Number Information
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NPI Number | 1245580174
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Entity Type | Organization
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Legal Business Name | SLENDER SPA MED ENTERPRISES, LLC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 1475 HOLCOMB BRIDGE RD SUITE 165
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City | ROSWELL
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State | GA
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Zip | 30076-2139
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Country | US
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Telephone | 678-682-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1475 HOLCOMB BRIDGE RD SUITE 165
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City | ROSWELL
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State | GA
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Zip | 30076-2139
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Country | US
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Telephone | 678-682-8600
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Fax | 678-682-8601
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TANYA GRIZZLE
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Credential |
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Telephone | 678-682-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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