Provider Demographics
NPI:1548098833
Name:SCULPTING CHOICES LLC
Entity type:Organization
Organization Name:SCULPTING CHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRAMAINE
Authorized Official - Middle Name:RENALDO
Authorized Official - Last Name:BLASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-777-0729
Mailing Address - Street 1:159 STEVEN DRIVE
Mailing Address - Street 2:204 BUILDING 1
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-777-0729
Mailing Address - Fax:
Practice Address - Street 1:159 STEVEN DRIVE
Practice Address - Street 2:204 BUILDING 1
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-777-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health