MEDICARE: ERIN WEBLEY RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1681	ND
2	133V00000X	Registered Dietitian	2025016573	MO
3	133V00000X	Registered Dietitian	6241-29	WI
4	133V00000X	Registered Dietitian	LD005502	GA

General Provider Information

NPI Number	:	1861349011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN WEBLEY RD

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-1010
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	616-443-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-1010
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	616-443-3263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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