# SOUTHERN WEIGHT LOSS CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699330985
- **Authorized official:** BETSY BLITCH (MANAGER)
- **Authorized official phone:** (912) 681-6334

## Contact information

- **Practice address:** 628 MULLINS COLONY DR, EVANS, GA 30809-0579
- **Practice address phone:** (912) 681-6334
- **Mailing address:** 628 MULLINS COLONY DR, EVANS, GA 30809-0579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/02/2019
- **Last updated:** 05/02/2019