Provider Demographics
NPI:1861209231
Name:FIRST STEP WEIGHT LOSS CLINIC LLC
Entity type:Organization
Organization Name:FIRST STEP WEIGHT LOSS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIMURENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-927-1428
Mailing Address - Street 1:7544 SOUTHLAKE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2495
Mailing Address - Country:US
Mailing Address - Phone:404-884-1461
Mailing Address - Fax:
Practice Address - Street 1:7544 SOUTHLAKE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2495
Practice Address - Country:US
Practice Address - Phone:404-884-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty