Organization
COASTAL NUTRITION SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY A YOUNGBLOOD JR. R.D., L.D., C.D.E. (OWNER)
(912) 660-1215
Entity
Organization
Contact information
Practice address
141 NANDINA WAY, POOLER, GA 31322-4076
(912) 660-1215
Mailing address
141 NANDINA WAY, POOLER, GA 31322-4076
(912) 660-1215
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002323
GA
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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