Provider Demographics
NPI:1962186072
Name:FOREVER YOUNG MEDICAL AESTHETICS AND WEIGHT LOSS LLC
Entity type:Organization
Organization Name:FOREVER YOUNG MEDICAL AESTHETICS AND WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-342-3335
Mailing Address - Street 1:102 PROFESSIONAL PARK PVT DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2287
Mailing Address - Country:US
Mailing Address - Phone:423-342-3335
Mailing Address - Fax:
Practice Address - Street 1:102 PROFESSIONAL PARK PVT DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2287
Practice Address - Country:US
Practice Address - Phone:423-342-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center