Individual
KATHERINE S NICKLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
157 CLINIC #203, CARROLLTON, GA 30117
(770) 832-0429
(770) 838-9108
Mailing address
157 CLINIC #203, CARROLLTON, GA 30117
(770) 832-0429
(770) 838-9108
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002692
GA
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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