Provider Demographics
NPI:1942556329
Name:AGELESS MENS HEALTH,LLC
Entity Type:Organization
Organization Name:AGELESS MENS HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-3643
Mailing Address - Street 1:2257 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2257 N GERMANTOWN PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7413
Practice Address - Country:US
Practice Address - Phone:901-757-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty