Provider Demographics
NPI:1861234221
Name:BODY EXPRESSIONS THE AESTHETIC EDGE
Entity type:Organization
Organization Name:BODY EXPRESSIONS THE AESTHETIC EDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:770-224-8604
Mailing Address - Street 1:2610 HOLLY SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9305
Mailing Address - Country:US
Mailing Address - Phone:770-224-8604
Mailing Address - Fax:470-863-5462
Practice Address - Street 1:2610 HOLLY SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-9305
Practice Address - Country:US
Practice Address - Phone:770-224-8604
Practice Address - Fax:470-863-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty