Organization
SOUTHERN NUTRITION AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATI REBECCA WISE MS, RD, LD (LICENSED DIETITIAN)
(229) 546-7585
Entity
Organization
Contact information
Practice address
6073 LUKE RD, RAY CITY, GA 31645-2119
(229) 546-7585
Mailing address
6073 LUKE RD, RAY CITY, GA 31645-2119
(229) 546-7585
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004663
GA
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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