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General NPI Number Information
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NPI Number | 1033622956
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Entity Type | Organization
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Legal Business Name | DHW ENTERPRISES
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 5300 BRICKLEBERRY WAY STE 104
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4065
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Country | US
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Telephone | 678-799-8613
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 NEW MACLAND RD # 200-129
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2000
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Country | US
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Telephone | 678-770-5247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANTEA JOHNSON
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Credential | MS, MPH, CHES
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Telephone | 678-770-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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