Provider Demographics
NPI:1497969216
Name:SOUTHERN WELLNESS & WEIGHT MANAGEMENT CENTER
Entity Type:Organization
Organization Name:SOUTHERN WELLNESS & WEIGHT MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:DOLLAR
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-745-2700
Mailing Address - Street 1:1773 SWEETWATER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-3294
Mailing Address - Country:US
Mailing Address - Phone:770-745-2700
Mailing Address - Fax:770-745-2703
Practice Address - Street 1:1773 SWEETWATER ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-3294
Practice Address - Country:US
Practice Address - Phone:770-745-2700
Practice Address - Fax:770-745-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036382261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care