Provider Demographics
NPI:1831526276
Name:NEXSLIM OF COBB COUNTY, LLC
Entity type:Organization
Organization Name:NEXSLIM OF COBB COUNTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-222-3043
Mailing Address - Street 1:1615 RIDENOUR BLVD NW
Mailing Address - Street 2:SUITE #202
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4463
Mailing Address - Country:US
Mailing Address - Phone:678-664-8446
Mailing Address - Fax:678-669-2000
Practice Address - Street 1:1615 RIDENOUR BLVD NW
Practice Address - Street 2:SUITE #202
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4463
Practice Address - Country:US
Practice Address - Phone:678-664-8446
Practice Address - Fax:678-669-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty