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General NPI Number Information
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NPI Number | 1841663366
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Entity Type | Organization
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Legal Business Name | NEW IMAGE WEIGHT LOSS
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 1956 RAINBOW DR
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City | GADSDEN
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State | AL
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Zip | 35901-5567
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Country | US
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Telephone | 256-438-5839
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Fax | 256-467-3130
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Provider Business Mailing Address
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Address Line | 1956 RAINBOW DR
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City | GADSDEN
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State | AL
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Zip | 35901-5567
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Country | US
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Telephone | 256-438-5839
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Fax | 256-467-3130
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER THRASHER
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Credential |
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Telephone | 256-438-5839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number | 905
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License Number State | AL
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