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General NPI Number Information
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NPI Number | 1326710526
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Entity Type | Organization
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Legal Business Name | INFUSE AESTHETICS AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 721 E SHOTWELL ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4063
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Country | US
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Telephone | 229-400-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 114 PINE BLOOM DR
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City | BAINBRIDGE
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State | GA
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Zip | 39819-6540
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Country | US
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Telephone | 229-220-7755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITTNEY LONDON TYUS
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Credential | NP
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Telephone | 229-220-7755
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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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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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