Provider Demographics
NPI:1134686090
Name:BELTLINE WEIGHT LOSS LLC
Entity Type:Organization
Organization Name:BELTLINE WEIGHT LOSS LLC
Other - Org Name:BELTLINE WEIGHT LOSS AND OBESITY MEDICINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:KAPOU
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-524-1010
Mailing Address - Street 1:2110 POWERS FERRY RD SE STE 302
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5015
Mailing Address - Country:US
Mailing Address - Phone:470-419-4380
Mailing Address - Fax:470-298-7736
Practice Address - Street 1:371 E PACES FERRY RD NE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2372
Practice Address - Country:US
Practice Address - Phone:470-419-4380
Practice Address - Fax:470-298-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty