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Individual

MS. MARY ANN B FLORESTAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD, LD

Contact information

Practice address
4757 CANTON RD, SUITE 110, MARIETTA, GA 30066-3234
(770) 517-0105
(770) 517-0105
Mailing address
4757 CANTON RD, NE, SUITE 110, MARIETTA, GA 30066-3234
(770) 517-0105
(770) 517-0105

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001660
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10040673
AMERIGROUP
GA
01
332644
WELLCARE
GA
Enumeration date
01/02/2007
Last updated
07/08/2007
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