=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609534114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENKE INVESTMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2021
-----------------------------------------------------
Last Update Date | 02/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 277 HIGHWAY 74 N STE 210
-----------------------------------------------------
City | PEACHTREE CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-628-5660
-----------------------------------------------------
Fax | 770-679-8752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 277 HIGHWAY 74 N STE 210
-----------------------------------------------------
City | PEACHTREE CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-628-5660
-----------------------------------------------------
Fax | 770-679-8752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VANESSA K MENKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-595-4700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RB0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------