Provider Demographics
NPI:1326710526
Name:INFUSE AESTHETICS AND WELLNESS, LLC
Entity Type:Organization
Organization Name:INFUSE AESTHETICS AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:LONDON
Authorized Official - Last Name:TYUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:229-220-7755
Mailing Address - Street 1:114 PINE BLOOM DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-6540
Mailing Address - Country:US
Mailing Address - Phone:229-220-7755
Mailing Address - Fax:
Practice Address - Street 1:721 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4063
Practice Address - Country:US
Practice Address - Phone:229-400-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty