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General NPI Number Information
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NPI Number | 1689876021
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Entity Type | Organization
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Legal Business Name | WEIGHT LOSS & WELLNESS CLINIC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16507 NORTHCROSS DR STE F
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5082
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Country | US
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Telephone | 704-728-7283
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Fax |
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Provider Business Mailing Address
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Address Line | 16507 NORTHCROSS DR STE F
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5082
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Country | US
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Telephone | 704-728-7283
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | DEBORAH E BAIRD
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Credential |
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Telephone | 704-728-7283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 261AM1300X
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License Number State | NC
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