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General NPI Number Information
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NPI Number | 1962186072
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Entity Type | Organization
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Legal Business Name | FOREVER YOUNG MEDICAL AESTHETICS AND WEIGHT LOSS LLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 102 PROFESSIONAL PARK PVT DR
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City | KINGSPORT
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State | TN
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Zip | 37663-2287
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Country | US
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Telephone | 423-342-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 102 PROFESSIONAL PARK PVT DR
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City | KINGSPORT
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State | TN
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Zip | 37663-2287
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Country | US
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Telephone | 423-342-3335
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Fax |
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Authorized Official
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Title or Position | FNP/OWNER
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Name | HEATHER N WILLIAMS
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Credential | FNP
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Telephone | 423-342-3335
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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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