Provider Demographics
NPI:1245322395
Name:AESCULAPIAN AESTHETIC ANTI AGING INSTITUTE, LLC
Entity type:Organization
Organization Name:AESCULAPIAN AESTHETIC ANTI AGING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:901-259-7000
Mailing Address - Street 1:6286 BRIARCREST AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4023
Mailing Address - Country:US
Mailing Address - Phone:901-259-7000
Mailing Address - Fax:901-259-7033
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-7000
Practice Address - Fax:901-259-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000006966207RH0000X, 2083P0901X
2083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty