Walter Carl Ehrenfeuchter, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

057453 Issued in GA

Practice address

625 Old Peachtree Rd NW
Suite 104
Suwanee, GA 30024-2937

Phone

(678) 225-7485

Fax

(678) 225-7489

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1912968223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 OLD PEACHTREE RD NW",
            "address_2": "SUITE 104",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242937",
            "telephone_number": "678-225-7485",
            "fax_number": "678-225-7489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 OLD PEACHTREE RD NW",
            "address_2": "SUITE 104",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242937",
            "telephone_number": "678-225-7485",
            "fax_number": "678-225-7489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHRENFEUCHTER",
        "first_name": "WALTER",
        "middle_name": "CARL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "GA",
            "license": "057453",
            "primary": true
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "PA",
            "license": "OS004445L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.