Provider Demographics
NPI:1518270115
Name:SELF CENTERED WEIGHT LOSS AND WELLNESS OF MURFREESBORO, PLLC
Entity Type:Organization
Organization Name:SELF CENTERED WEIGHT LOSS AND WELLNESS OF MURFREESBORO, PLLC
Other - Org Name:MITCHELL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-849-7777
Mailing Address - Street 1:1211 LEAF AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2642
Mailing Address - Country:US
Mailing Address - Phone:615-849-7777
Mailing Address - Fax:615-849-7753
Practice Address - Street 1:1211 LEAF AVE STE 102
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2642
Practice Address - Country:US
Practice Address - Phone:615-849-7777
Practice Address - Fax:615-849-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3499953Medicaid
TN1518270115OtherGROUP NPI NUMBER