Individual
MRS. MANASI DIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, RD LD
Contact information
Practice address
901 E LAKE PKWY, MARIETTA, GA 30062
(678) 360-1650
Mailing address
901 E LAKE PKWY, MARIETTA, GA 30062
(678) 360-1650
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004126
GA
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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