Individual
MARY E ORTWEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
603 E VILLANOW ST, LA FAYETTE, GA 30728-2618
(706) 638-5577
(706) 638-5543
Mailing address
603 E VILLANOW ST, PO BOX 609, LA FAYETTE, GA 30728-2618
(706) 638-5577
(706) 638-5543
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
LD000701
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10072172
—
GA
Enumeration date
03/14/2008
Last updated
03/14/2008
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