Individual
AJ DOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD, LD
Contact information
Practice address
54 MIDDLEBROOK DR, CARTERSVILLE, GA 30120-7935
(470) 273-0876
Mailing address
54 MIDDLEBROOK DR, CARTERSVILLE, GA 30120-7935
(470) 273-0876
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004289
GA
Other
Enumeration date
10/10/2024
Last updated
12/05/2024
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