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General NPI Number Information
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NPI Number | 1346040607
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Entity Type | Organization
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Legal Business Name | GENESIS WELLNESS WEIGHT LOSS AND AESTHETICS LLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2855 STAGE VILLAGE CV STE 5
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City | BARTLETT
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State | TN
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Zip | 38134-4616
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Country | US
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Telephone | 901-245-1975
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Fax | 901-688-2098
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Provider Business Mailing Address
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Address Line | 2855 STAGE VILLAGE CV STE 5
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City | BARTLETT
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State | TN
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Zip | 38134-4616
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Country | US
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Telephone | 901-245-1975
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Fax | 901-688-2098
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Authorized Official
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Title or Position | NURSE PRACTITIONER / OWNER
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Name | MRS. SOPHIA NOBLE
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Credential | FNP
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Telephone | 901-830-8850
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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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