Healthcare Provider Details

I. General information

NPI: 1821848243
Provider Name (Legal Business Name): EMILY NEUHAUS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 INDIAN LAKE DR NW
LILBURN GA
30047-6805
US

IV. Provider business mailing address

896 INDIAN LAKE DR NW
LILBURN GA
30047-6805
US

V. Phone/Fax

Practice location:
  • Phone: 678-821-9040
  • Fax:
Mailing address:
  • Phone: 678-821-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: