Healthcare Provider Details

I. General information

NPI: 1033622956
Provider Name (Legal Business Name): DHW ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BRICKLEBERRY WAY STE 104
DOUGLASVILLE GA
30134-4065
US

IV. Provider business mailing address

3721 NEW MACLAND RD # 200-129
POWDER SPRINGS GA
30127-2000
US

V. Phone/Fax

Practice location:
  • Phone: 678-799-8613
  • Fax:
Mailing address:
  • Phone: 678-770-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: SHANTEA JOHNSON
Title or Position: OWNER
Credential: MS, MPH, CHES
Phone: 678-770-5247