Individual
MRS. MARY LAUREN WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D, C.S.P, L.D.
Contact information
Practice address
4700 WATERS AVE, FOOD & NUTRITION SERVICES, SAVANNAH, GA 31404-6220
(912) 350-9473
(843) 350-9557
Mailing address
4700 WATERS AVE, P.O. BOX 23089, SAVANNAH, GA 31404-6220
(912) 350-9473
(843) 350-9557
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
003750
GA
133VN1004X
Pediatric Nutrition Registered Dietitian
160
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003124845A
—
GA
Enumeration date
04/09/2008
Last updated
09/27/2012
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