NPIMap

Organization Active NPI

Express Weight Loss of Georgia

  • Specialist
  • Loganville, GA
National Provider Identifier
1073865242
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
36409 Issued in GA
Legal business name
EXPRESS WEIGHT LOSS OF GEORGIA
Practice address
4451 Atlanta Hwy
Suite a
Loganville, GA 30052-7310
Phone
(678) 609-8446
Fax
(678) 436-8858
NPI assigned
Oct 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas Locke III, M.D.
Title
Medical Director
Phone
(678) 609-8446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 36409 GA Primary

Addresses

Primary practice location

4451 Atlanta Hwy
Suite a
Loganville, GA 30052-7310

Mailing address

4451 Atlanta Hwy
Suite a
Loganville, GA 30052-7310
Phone (678) 609-8446

National Provider Directory

National Provider Directory

Locations

4451 Atlanta Hwy
Ste A
Loganville, GA 30052
Phone (678) 609-8446

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1073865242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 ATLANTA HWY",
            "address_2": "SUITE A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527310",
            "telephone_number": "678-609-8446",
            "fax_number": "678-436-8858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 ATLANTA HWY",
            "address_2": "SUITE A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527310",
            "telephone_number": "678-609-8446",
            "fax_number": "678-436-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESS WEIGHT LOSS OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-11",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-609-8446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "36409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.