NPIMap

Organization Active NPI

Southern Weight Loss Clinic, LLC

  • Family Medicine Physician
  • Marietta, GA
National Provider Identifier
1740748870
Registry record updated Mar 14, 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
3600 Dallas Hwy SW Ste 210
Marietta, GA 30064-1687
Phone
(770) 628-5633
NPI assigned
Mar 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Authorized official

Name
Betsy Stanridge
Title
Administrator
Phone
(770) 628-5633

Specialties & licenses 1

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

Addresses

Primary practice location

3600 Dallas Hwy SW Ste 210
Marietta, GA 30064-1687

Mailing address

3600 Dallas Hwy SW Ste 210
Marietta, GA 30064-1687
Phone (770) 628-5633

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.

NPI Registry JSON

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1740748870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 DALLAS HWY SW STE 210",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641687",
            "telephone_number": "770-628-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 DALLAS HWY SW STE 210",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641687",
            "telephone_number": "770-628-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WEIGHT LOSS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-07",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "STANRIDGE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-628-5633"
    },
    "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 Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.