Provider Demographics
NPI:1912968223
Name:EHRENFEUCHTER, WALTER CARL (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:CARL
Last Name:EHRENFEUCHTER
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:625 OLD PEACHTREE RD NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2937
Mailing Address - Country:US
Mailing Address - Phone:678-225-7485
Mailing Address - Fax:678-225-7489
Practice Address - Street 1:625 OLD PEACHTREE RD NW
Practice Address - Street 2:SUITE 104
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2937
Practice Address - Country:US
Practice Address - Phone:678-225-7485
Practice Address - Fax:678-225-7489
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA057453204D00000X
PAOS004445L204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM