Organization
FOURTH AND BEECH, INC.
Active
Other names
Medi-Weightloss
Organization subpart
No
Provider details
NPI number
Authorized official
IKUSUKE NAKADA (CEO/OWNER)
(404) 229-9048
Entity
Organization
Contact information
Practice address
5475 CHAMBLEE DUNWOODY RD, DUNWOODY, GA 30338-4114
(678) 379-1300
(678) 802-3209
Mailing address
5024 VERNON SPRINGS DR, DUNWOODY, GA 30338-4653
(404) 229-9048
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
LD004684
GA
207Q00000X
Family Medicine Physician
Primary
56363
GA
207Q00000X
Family Medicine Physician
RN108447
GA
Other
Enumeration date
04/25/2016
Last updated
07/19/2016
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