Provider Demographics
NPI:1811394539
Name:ENZWEILER, ERIN (RD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:ENZWEILER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 POWERS FERRY RD SE BLDG 22
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5621
Mailing Address - Country:US
Mailing Address - Phone:404-702-1982
Mailing Address - Fax:
Practice Address - Street 1:1827 POWERS FERRY RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:404-702-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR-3142101YM0800X
GA133V00000X, 101Y00000X
ORLD-D-10156897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered