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General NPI Number Information
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NPI Number | 1952739229
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Entity Type | Organization
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Legal Business Name | MERIDIAN WEIGHT MANAGEMENT CENTER
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 1715 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3104
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Country | US
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Telephone | 601-696-6736
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Fax | 601-696-6778
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Provider Business Mailing Address
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Address Line | 1715 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3104
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Country | US
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Telephone | 601-696-6736
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Fax | 601-696-6778
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DAVID E BONNER
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Credential | RN
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Telephone | 601-696-6736
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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 | 17693
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License Number State | MS
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