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General NPI Number Information
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NPI Number | 1427496173
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Entity Type | Organization
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Legal Business Name | CAROLINAS WEIGHT MANAGEMENT
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 2608 E. 7TH ST.
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City | CHARLOTTE
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State | NC
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Zip | 28204
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Country | US
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Telephone | 704-355-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 2608 E 7TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-4375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | STEPHANIE ANN KINNER
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Credential | RD, LDN
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Telephone | 704-355-9484
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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 | L004000
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License Number State | NC
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