Healthcare Provider Details

I. General information

NPI: 1083106231
Provider Name (Legal Business Name): B. WHEELER NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
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:
Mailing address:
  • Phone: 678-951-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberLD003714
License Number StateGA

VIII. Authorized Official

Name: BETHANY WHEELER
Title or Position: OWNER
Credential: MS, RD, LD
Phone: 678-951-9584