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Individual

MS. YAQUTULLAH IBRAHEEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
4071 CODEL ST SW, ATLANTA, GA 30331-4355
(404) 454-7356
Mailing address
2670 MIRIAM LN, DECATUR, GA 30032-5731
(404) 454-7356

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
003181
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1346472834
NPI
GA
Enumeration date
08/17/2009
Last updated
12/19/2018
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