Healthcare Provider Details

I. General information

NPI: 1205394368
Provider Name (Legal Business Name): BETHANY WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 ROSELANE ST NW STE 400-145
MARIETTA GA
30060-6913
US

IV. Provider business mailing address

531 ROSELANE ST NW STE 400-145
MARIETTA GA
30060-6913
US

V. Phone/Fax

Practice location:
  • Phone: 678-951-9584
  • Fax: 678-550-7590
Mailing address:
  • Phone: 678-951-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: