NPIMap

Organization Active NPI

Southern Weight Loss Clinic, LLC

  • Family Medicine Physician
  • Evans, GA
National Provider Identifier
1699330985
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHERN WEIGHT LOSS CLINIC, LLC
Practice address
628 Mullins Colony Dr
Evans, GA 30809-0579
Phone
(912) 681-6334
NPI assigned
May 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Authorized official

Name
Betsy Blitch
Title
Manager
Phone
(912) 681-6334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

628 Mullins Colony Dr
Evans, GA 30809-0579

Mailing address

628 Mullins Colony Dr
Evans, GA 30809-0579

National Provider Directory

National Provider Directory
Tax ID family
Southern Weight Loss Clinic LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

628 Mullins Colony Dr
Evans, GA 30809
Phone (912) 681-6334

NPI Registry JSON

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1699330985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 MULLINS COLONY DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308090579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 MULLINS COLONY DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308090579",
            "telephone_number": "912-681-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WEIGHT LOSS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "BLITCH",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-681-6334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; 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.