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Organization
SOUTHERN NUTRITION AND WELLNESS
Active
Organization
SOUTHERN NUTRITION AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATI REBECCA WISE MS, RD, LD (LICENSED DIETITIAN)
(229) 546-7585
Entity
Organization
Contact information
Practice address
6073 LUKE RD, RAY CITY, GA 31645-2119
(229) 546-7585
Mailing address
6073 LUKE RD, RAY CITY, GA 31645-2119
(229) 546-7585
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004663
GA
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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