Healthcare Provider Details

I. General information

NPI: 1811394539
Provider Name (Legal Business Name): ERIN ENZWEILER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE
ATLANTA GA
30339
US

IV. Provider business mailing address

1827 POWERS FERRY RD SE BLDG 22
ATLANTA GA
30339-5621
US

V. Phone/Fax

Practice location:
  • Phone: 404-702-1982
  • Fax:
Mailing address:
  • Phone: 404-702-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR-3142
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10156897
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: