Individual
MARY NOVARAH MATTIACCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2726 OAK VILLAGE TRL, DECATUR, GA 30032-6496
(707) 387-6643
Mailing address
2726 OAK VILLAGE TRL, DECATUR, GA 30032-6496
(707) 387-6643
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004495
GA
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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