Organization
NORTH GEORGIA NUTRITION AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE DAVIS (PRESIDENT)
(770) 718-6736
Entity
Organization
Contact information
Practice address
3617 BRASELTON HWY, SUITE 104, DACULA, GA 30019-4667
(770) 718-6736
Mailing address
2709 LEGISLATIVE LN, BUFORD, GA 30519-8037
(770) 718-6736
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD001208
GA
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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