Provider Demographics
NPI:1477259406
Name:SOUTHEAST MEDSPA LASER & WELLNESS
Entity Type:Organization
Organization Name:SOUTHEAST MEDSPA LASER & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:919-243-8146
Mailing Address - Street 1:2076 NC 42
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-243-8146
Mailing Address - Fax:
Practice Address - Street 1:2076 NC 42
Practice Address - Street 2:SUITE 200
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-243-8146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization