Organization
NUTRITIONMAGIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANN C. LAFONTAINE MA,RD,LD (PRESIDENT)
(706) 579-1992
Entity
Organization
Contact information
Practice address
4054 SOARING HAWK CIRCLE, 11563 BIG CANOE, JASPER, GA 30143-5115
(706) 579-1992
(866) 900-4295
Mailing address
4054 SOARING HAWK CIRCLE, 11563 BIG CANOE, JASPER, GA 30143-5115
(706) 579-1992
(866) 900-4295
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD000961
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669570917
NPI
GA
Enumeration date
03/02/2010
Last updated
03/02/2010
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