Provider Demographics
NPI:1275813263
Name:JMC AESTHETICS, LLC
Entity Type:Organization
Organization Name:JMC AESTHETICS, LLC
Other - Org Name:JMC RESTORATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-456-7206
Mailing Address - Street 1:2001 BISCAYNE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5056
Mailing Address - Country:US
Mailing Address - Phone:305-456-7206
Mailing Address - Fax:305-456-7688
Practice Address - Street 1:2001 BISCAYNE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5056
Practice Address - Country:US
Practice Address - Phone:305-456-7206
Practice Address - Fax:305-456-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95727208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty