Individual
MRS. DONNA P DECAILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1922 HIGHWAY 74 N, SUITE D, TYRONE, GA 30290-1660
(404) 797-0528
(678) 489-8957
Mailing address
1922 HIGHWAY 74 N, SUITE D, TYRONE, GA 30290-1660
(404) 797-0528
(678) 489-8957
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002627
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24020797A
—
GA
Enumeration date
05/18/2006
Last updated
06/19/2010
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