# YOUR DIETITIAN LLC

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

## Provider details

- **NPI number:** 1609104058
- **Authorized official:** GENEVIEVE BROOMFIELD RD, CSR, LD (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (770) 356-9468

## Contact information

- **Practice address:** 2758 FELTON DR, EAST POINT, GA 30344-3604
- **Practice address phone:** (770) 356-9468
- **Practice address fax:** (678) 547-3156
- **Mailing address:** 908 NEEDLETOP CT, MCDONOUGH, GA 30253-4315
- **Mailing address phone:** (770) 356-9468
- **Mailing address fax:** (678) 547-3156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | LD001151 | GA | — |
| 133VN1005X | Renal Nutrition Registered Dietitian | LD001151 | GA | Yes |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | LD001151 | GA | — |

## Other

- **Enumeration date:** 11/23/2009
- **Last updated:** 11/23/2009