Provider Demographics
NPI:1104217942
Name:NUTRITION SYSTEMS WELLNESS, LLC
Entity Type:Organization
Organization Name:NUTRITION SYSTEMS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OGDEN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-927-4928
Mailing Address - Street 1:PO BOX 5229
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-5229
Mailing Address - Country:US
Mailing Address - Phone:601-984-3126
Mailing Address - Fax:601-984-3127
Practice Address - Street 1:603 DULING AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4009
Practice Address - Country:US
Practice Address - Phone:601-984-3126
Practice Address - Fax:601-984-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty