# NUTRITION 411 BEVERLY FORD RD LD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225220866
- **Authorized official:** BEVERLY FORD RD LD (OWNER)
- **Authorized official phone:** (706) 589-1582

## Contact information

- **Practice address:** 2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
- **Practice address phone:** (706) 589-1582
- **Mailing address:** 2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
- **Mailing address phone:** (706) 589-1582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1005X | Renal Nutrition Registered Dietitian | 000488 | GA | Yes |

## Other

- **Enumeration date:** 08/17/2007
- **Last updated:** 08/17/2007