Individual
JOYCE ELAINE OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D. L.D. M.S.
Contact information
Practice address
1826 VETERANS BLVD, DUBLIN, GA 31021-3620
(478) 272-1210
Mailing address
2201 KINGS DR, DUBLIN, GA 31021-2884
(478) 272-1210
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
30336
IL
133V00000X
Registered Dietitian
Primary
LD001552
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
303362
REGISTERED DIETITIAN
—
01
—
LD001552
LICENSED DIETITIAN
GA
Enumeration date
09/29/2006
Last updated
07/08/2007
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