Provider Demographics
NPI:1871061713
Name:SCULPTURES BODY SPA
Entity type:Organization
Organization Name:SCULPTURES BODY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:470-277-3552
Mailing Address - Street 1:885 HIGHWAY 138 W
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4261
Mailing Address - Country:US
Mailing Address - Phone:470-377-2552
Mailing Address - Fax:
Practice Address - Street 1:885 HIGHWAY 138 W
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4261
Practice Address - Country:US
Practice Address - Phone:470-377-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty