Individual
MS. STEPHANIE LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2417 CHASTAIN DR NE # 2417, ATLANTA, GA 30342-4157
(610) 864-4344
Mailing address
2417 CHASTAIN DR NE # 2417, ATLANTA, GA 30342-4157
(610) 864-4344
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
171400000X
Health & Wellness Coach
Primary
—
—
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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