Provider Demographics
NPI:1598490252
Name:EVOLUTION HEALTH AND WELLNESS, INC.
Entity Type:Organization
Organization Name:EVOLUTION HEALTH AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:404-229-9659
Mailing Address - Street 1:90 SPRING LAKE PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1646
Mailing Address - Country:US
Mailing Address - Phone:404-229-9659
Mailing Address - Fax:
Practice Address - Street 1:90 SPRING LAKE PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1646
Practice Address - Country:US
Practice Address - Phone:404-229-9659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service