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General NPI Number Information
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NPI Number | 1518281864
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Entity Type | Organization
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Legal Business Name | AGELESS MENS HEALTH
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 2941 PIEDMONT RD NE SUITE B
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City | ATLANTA
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State | GA
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Zip | 30305-2784
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Country | US
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Telephone | 404-841-9445
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Fax | 901-841-9446
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Provider Business Mailing Address
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Address Line | 10501 W GOWAN RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89129-6602
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Country | US
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Telephone | 602-796-2559
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Fax |
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Authorized Official
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Title or Position | BUSINESS OPERATIONS DIRECTOR
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Name | AMANDA WILKINSON
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Credential |
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Telephone | 602-796-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5765
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License Number State | GA
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