Individual
POUTHEAVY LAT TEP-RUTKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
2295 RONALD REAGAN PKWY STE 300, SNELLVILLE, GA 30078-5739
(770) 982-4115
Mailing address
577 IVES CIR NW, LILBURN, GA 30047-8726
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86296100
GA
Other
Enumeration date
06/22/2023
Last updated
06/22/2023
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