1316201015 NPI number — M. EUGENIA COUCHOUD-WILKINSON M.S., R.D.N, L.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316201015 NPI number — M. EUGENIA COUCHOUD-WILKINSON M.S., R.D.N, L.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUCHOUD-WILKINSON
Provider First Name:
M. EUGENIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., R.D.N, L.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316201015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
263 HERON LAKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043-6850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-575-1966
Provider Business Mailing Address Fax Number:
678-288-8234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11340 LAKEFIELD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-407-2159
Provider Business Practice Location Address Fax Number:
678-288-8234
Provider Enumeration Date:
06/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LD003876 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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