Individual
MARY GLYNN BAZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CPT
Contact information
Practice address
420 TAYLOR DR, FORSYTH, GA 31029-8506
(205) 837-4882
Mailing address
261 PROVIDENCE BLVD, MACON, GA 31210-7565
(205) 837-4882
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86176913
AL
Other
Enumeration date
08/19/2022
Last updated
05/30/2024
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