Organization
PREMIER AGE MANAGEMENT AND MEDICAL WEIGHT LOSS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM RYAN WALKER ESQ. (ADMINISTRATIVE DIRECTOR)
(615) 649-9600
Entity
Organization
Contact information
Practice address
229 WARD CIR, A-23, BRENTWOOD, TN 37027-7518
(615) 649-9600
(615) 649-9601
Mailing address
229 WARD CIR, A-23, BRENTWOOD, TN 37027-7518
(615) 649-9600
(615) 649-9601
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
—
—
133N00000X
Nutritionist
—
—
207Q00000X
Family Medicine Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
—
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
TN
363L00000X
Nurse Practitioner
—
TN
Other
Enumeration date
07/08/2013
Last updated
07/08/2013
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