Organization
BLOOM FUNCTIONAL NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALORIE BLAKE RD (OWNER)
(717) 634-4227
Entity
Organization
Contact information
Practice address
322 TIMBERLAND CIR, RICHMOND HILL, GA 31324-6398
(717) 634-4227
Mailing address
322 TIMBERLAND CIR, RICHMOND HILL, GA 31324-6398
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
01/23/2017
Last updated
01/30/2024
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