Provider Demographics
NPI:1649766874
Name:NUTRITIONECW LLC
Entity Type:Organization
Organization Name:NUTRITIONECW LLC
Other - Org Name:EUGENIA COUCHOUD-WILKINSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCHOUD-WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:678-407-2159
Mailing Address - Street 1:263 HERON LAKE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6850
Mailing Address - Country:US
Mailing Address - Phone:678-407-2159
Mailing Address - Fax:678-288-8234
Practice Address - Street 1:1755 NORTH BROWN RD
Practice Address - Street 2:STE.200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:678-407-2159
Practice Address - Fax:678-288-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316201015OtherNPI TYPE 1