Organization
EXPRESS WEIGHT LOSS OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS LOCKE III M.D. (MEDICAL DIRECTOR)
(678) 609-8446
Entity
Organization
Contact information
Practice address
4451 ATLANTA HWY, SUITE A, LOGANVILLE, GA 30052-7310
(678) 609-8446
(678) 436-8858
Mailing address
4451 ATLANTA HWY, SUITE A, LOGANVILLE, GA 30052-7310
(678) 609-8446
(678) 436-8858
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36409
GA
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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