Provider Demographics
NPI:1942067848
Name:BABS AESTHETIC PLLC
Entity type:Organization
Organization Name:BABS AESTHETIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-294-1761
Mailing Address - Street 1:9539 WARHAWK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8040
Mailing Address - Country:US
Mailing Address - Phone:850-294-1761
Mailing Address - Fax:
Practice Address - Street 1:715 2ND AVE N
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3424
Practice Address - Country:US
Practice Address - Phone:850-294-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty