Provider Demographics
NPI:1588803720
Name:RESOLUTION FAMILY WEIGHT LOSS AND WELLNESS CENTER
Entity Type:Organization
Organization Name:RESOLUTION FAMILY WEIGHT LOSS AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-510-9464
Mailing Address - Street 1:2231 BEMISS RD
Mailing Address - Street 2:B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4812
Mailing Address - Country:US
Mailing Address - Phone:229-219-8565
Mailing Address - Fax:229-219-8575
Practice Address - Street 1:2231 BEMISS RD
Practice Address - Street 2:B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4812
Practice Address - Country:US
Practice Address - Phone:229-219-8565
Practice Address - Fax:229-219-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center