Provider Demographics
NPI:1427739903
Name:TENNESSEE STYLE WEIGHT LOSS LLC
Entity type:Organization
Organization Name:TENNESSEE STYLE WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOU-HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-229-4338
Mailing Address - Street 1:355 NEW SHACKLE ISLAND RD STE 128B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2479
Mailing Address - Country:US
Mailing Address - Phone:309-229-4338
Mailing Address - Fax:
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD STE 128B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2479
Practice Address - Country:US
Practice Address - Phone:309-229-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty