Organization
SOUTHERN WEIGHT LOSS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETSY STANRIDGE (ADMINISTRATOR)
(770) 628-5633
Entity
Organization
Contact information
Practice address
3600 DALLAS HWY SW STE 210, MARIETTA, GA 30064-1687
(770) 628-5633
Mailing address
3600 DALLAS HWY SW STE 210, MARIETTA, GA 30064-1687
(770) 628-5633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/07/2019
Last updated
03/14/2019
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