Express Weight Loss of Georgia

NPI #1073865242 in Loganville, Georgia

Provider Information

NPI Number: 1073865242
Entity Type: Organization
Organization Name: Express Weight Loss of Georgia
Primary Specialty: Specialist
Enumeration Date: Oct 11, 2012
Last Updated: Oct 11, 2012

Practice Location

Address: 4451 ATLANTA HWY
Address 2: SUITE A
City: Loganville
State: Georgia
ZIP Code: 30052-7310
Phone: (678) 609-8446

Authorized Official

Name: DR. THOMAS LOCKE III, M.D.
Title: MEDICAL DIRECTOR
Phone: (678) 609-8446

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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