Provider Demographics
NPI:1740899517
Name:WHOLESOME FUEL, LLC
Entity type:Organization
Organization Name:WHOLESOME FUEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:224-392-7578
Mailing Address - Street 1:3061 QUANTUM LN UNIT 310
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-8100
Mailing Address - Country:US
Mailing Address - Phone:224-392-7578
Mailing Address - Fax:
Practice Address - Street 1:985 PONCE DE LEON AVE NE UNIT 310
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4278
Practice Address - Country:US
Practice Address - Phone:224-392-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty