Provider Demographics
NPI:1386919280
Name:DOCTORS CHOICE ADVANTAGE MEDICAL AND WEIGHT MANAGEMENT SERVICES
Entity type:Organization
Organization Name:DOCTORS CHOICE ADVANTAGE MEDICAL AND WEIGHT MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-594-3438
Mailing Address - Street 1:960 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 2-5
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1963
Mailing Address - Country:US
Mailing Address - Phone:770-594-3438
Mailing Address - Fax:
Practice Address - Street 1:960 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 2-5
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1963
Practice Address - Country:US
Practice Address - Phone:770-594-3438
Practice Address - Fax:800-518-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care