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General NPI Number Information
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NPI Number | 1083106231
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Entity Type | Organization
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Legal Business Name | B. WHEELER NUTRITION, LLC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1300 RIDENOUR BLVD NW STE 212
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City | KENNESAW
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State | GA
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Zip | 30152-4529
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Country | US
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Telephone | 678-951-9584
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 RIDENOUR BLVD NW STE 212
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City | KENNESAW
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State | GA
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Zip | 30152-4529
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Country | US
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Telephone | 678-951-9584
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETHANY WHEELER
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Credential | MS, RD, LD
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Telephone | 678-951-9584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | LD003714
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License Number State | GA
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