Individual
LINDA D. MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 845-3789
Mailing address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 845-3789
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000891
GA
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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