Organization
NUTRITION 411 BEVERLY FORD RD LD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY FORD RD LD (OWNER)
(706) 589-1582
Entity
Organization
Contact information
Practice address
2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
(706) 589-1582
Mailing address
2425 WILLIAMS ST, AUGUSTA, GA 30904-6127
(706) 589-1582
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
000488
GA
Other
Enumeration date
08/17/2007
Last updated
08/17/2007
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