Provider Demographics
NPI:1811383938
Name:TD WELLNESS, LLC
Entity Type:Organization
Organization Name:TD WELLNESS, LLC
Other - Org Name:OROZCO NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:678-568-4717
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0795
Mailing Address - Country:US
Mailing Address - Phone:770-853-0851
Mailing Address - Fax:678-951-0508
Practice Address - Street 1:116 E HOWARD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3345
Practice Address - Country:US
Practice Address - Phone:678-568-4717
Practice Address - Fax:678-951-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20200N001Medicare UPIN