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Organization
NUTRISOURCE NUTRITIONAL SERVICES, INC.
Active
Organization
NUTRISOURCE NUTRITIONAL SERVICES, INC.
Active
Other names
NutriSource, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAUREN G. BAILEY R.D. (OWNER)
(912) 222-7755
Entity
Organization
Contact information
Practice address
504 BEACHVIEW DR, SUITE 2A, SAINT SIMONS ISLAND, GA 31522-4740
(912) 222-7755
(912) 434-7018
Mailing address
620 SEA ISLAND RD, PMB 273, SAINT SIMONS ISLAND, GA 31522-1767
(912) 222-7755
(912) 434-7018
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002579
GA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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