Individual
BETHANY WHEELING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD, CNSC
Contact information
Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(470) 241-7415
Mailing address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004357
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD004357
LICENSED DIETITIAN
GA
Enumeration date
03/22/2019
Last updated
03/22/2019
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