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1407736556 NPI number — WEIGHTWISE MEDICAL CLINIC P.C.

NPI Number: 1407736556
Health Care Provider/Practitioner: WEIGHTWISE MEDICAL CLINIC P.C.

Information about “1407736556” NPI (WEIGHTWISE MEDICAL CLINIC P.C.) exists in 1407736556 in HTML format HTML  |  1407736556 in plain Text format TXT  |  1407736556 in PDF (Portable Document Format) PDF  |  1407736556 in an XML format XML  formats.

NPI Number : 1407736556 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407736556",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WEIGHTWISE MEDICAL CLINIC P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8045 TARA BLVD STE 299",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JONESBORO",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30236-3294",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-577-8613",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4300 PACES FERRY RD SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30339-5703",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-427-1009",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/08/2025",
    "LastUpdateDate": "02/25/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WATSON",
    "AuthorizedOfficialFirstName": "ALICIA",
    "AuthorizedOfficialMiddleName": "LAVETTE",
    "AuthorizedOfficialTitle": "CEO, OWNER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NURSE PRACTITIONER",
    "AuthorizedOfficialTelephoneNumber": "470-593-9632",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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