# SPROUT PEDIATRIC NUTRITION LLC

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

## Provider details

- **NPI number:** 1609550599
- **Authorized official:** CAITLIN WADDLE MS, RDN, LD (OWNER)
- **Authorized official phone:** (404) 654-3906

## Contact information

- **Practice address:** 4045 ORCHARD RD SE STE 500, SMYRNA, GA 30080-4900
- **Practice address phone:** (404) 654-3906
- **Mailing address:** 2062 VILLAGE CREST DR NW, ATLANTA, GA 30318-1064
- **Mailing address phone:** (502) 648-9464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2023
- **Last updated:** 06/12/2023