Provider Demographics
NPI:1902671399
Name:UPTOWN SPA AND SUITES
Entity Type:Organization
Organization Name:UPTOWN SPA AND SUITES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:706-888-2054
Mailing Address - Street 1:719 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2956
Mailing Address - Country:US
Mailing Address - Phone:706-221-0022
Mailing Address - Fax:
Practice Address - Street 1:719 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2956
Practice Address - Country:US
Practice Address - Phone:706-221-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare