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Individual

MISS JESSICA DENISE MACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
705 DALLAS HWY, VILLA RICA, GA 30180-1247
(770) 456-3249
(770) 456-3351
Mailing address
5497 LAKEVIEW PKWY, VILLA RICA, GA 30180-7856
(770) 456-3249

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002855
GA

Other

Enumeration date
05/16/2007
Last updated
07/08/2007
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