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General NPI Number Information
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NPI Number | 1649004334
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Entity Type | Organization
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Legal Business Name | SKIN AESTHETICS LLC
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 5447 US-127 N.
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City | CROSSVILLE
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State | TN
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Zip | 38571
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Country | US
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Telephone | 931-337-2921
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Fax |
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Provider Business Mailing Address
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Address Line | 5447 US-127 N.
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City | CROSSVILLE
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State | TN
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Zip | 38571
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Country | US
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Telephone | 931-337-2921
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHYSICIAN
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Name | DR. BRADY HARRIS
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Credential | MD
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Telephone | 931-337-2921
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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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