Provider Demographics
NPI:1245671114
Name:GENESIS WEIGHT AND AGE MANAGEMENT
Entity type:Organization
Organization Name:GENESIS WEIGHT AND AGE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-442-8586
Mailing Address - Street 1:2207 CRESTMOOR RD
Mailing Address - Street 2:STE 204
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2037
Mailing Address - Country:US
Mailing Address - Phone:615-442-8586
Mailing Address - Fax:615-442-8587
Practice Address - Street 1:2207 CRESTMOOR RD
Practice Address - Street 2:STE 204
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2037
Practice Address - Country:US
Practice Address - Phone:615-442-8586
Practice Address - Fax:615-442-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care