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Organization
NUTRITION 411 BEVERLY FORD RD LD LLC
Active
Organization
NUTRITION 411 BEVERLY FORD RD LD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY FORD RD LD (OWNER)
(706) 589-1582
Entity
Organization
Contact information
Practice address
2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
(706) 589-1582
Mailing address
2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
(706) 589-1582
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
000488
GA
Other
Enumeration date
08/17/2007
Last updated
08/17/2007
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