# PHYSICIANS PREMIERE WEIGHT & WELLNESS CENTER, P.L.L.C.

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

## Provider details

- **NPI number:** 1952961989
- **Authorized official:** KARI TISSANDIER (OFFICE MANAGER)
- **Authorized official phone:** (757) 406-6645

## Contact information

- **Practice address:** 25055 RIDING PLZ STE 230, CHANTILLY, VA 20152-5920
- **Practice address phone:** (703) 783-5673
- **Practice address fax:** (703) 297-8100
- **Mailing address:** 23289 MEADOWVALE GLEN CT, DULLES, VA 20166-2151
- **Mailing address phone:** (703) 783-5673
- **Mailing address fax:** (703) 297-8100

## Taxonomy

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

## Other

- **Enumeration date:** 06/20/2019
- **Last updated:** 06/20/2019