Provider Demographics
NPI:1629432455
Name:ADVANCED WEIGHT LOSS AND MED CARE CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED WEIGHT LOSS AND MED CARE CENTER, LLC
Other - Org Name:RESOLVE MEDICAL WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:404-275-2552
Mailing Address - Street 1:504 WALDO ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3424
Mailing Address - Country:US
Mailing Address - Phone:770-487-3200
Mailing Address - Fax:229-516-1440
Practice Address - Street 1:371 E PACES FERRY RD NE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2372
Practice Address - Country:US
Practice Address - Phone:770-487-3200
Practice Address - Fax:229-516-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care