Provider Demographics
NPI:1033622956
Name:DHW ENTERPRISES
Entity Type:Organization
Organization Name:DHW ENTERPRISES
Other - Org Name:DHW NUTRITION & FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPH, CHES
Authorized Official - Phone:678-770-5247
Mailing Address - Street 1:3721 NEW MACLAND RD # 200-129
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2000
Mailing Address - Country:US
Mailing Address - Phone:678-770-5247
Mailing Address - Fax:
Practice Address - Street 1:5300 BRICKLEBERRY WAY STE 104
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-4065
Practice Address - Country:US
Practice Address - Phone:678-799-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty