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Organization
ENVISION NUTRITION INC.
Active
Organization
ENVISION NUTRITION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA P DECAILLE RD (EXECUTIVE DIRECTOR)
(404) 797-0528
Entity
Organization
Contact information
Practice address
1922 HIGHWAY 74 N, SUITE D, TYRONE, GA 30290-1660
(404) 797-0528
Mailing address
1922 HIGHWAY 74 N, SUITE D, TYRONE, GA 30290-1660
(404) 797-0528
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD00262
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240270797A
—
GA
Enumeration date
06/22/2010
Last updated
06/22/2010
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