Individual
LISA MICHELLE ELLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
316 LAKESTONE LNDG, WOODSTOCK, GA 30188-5428
(678) 360-5796
Mailing address
316 LAKESTONE LNDG, WOODSTOCK, GA 30188-5428
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD004985
GA
Other
Enumeration date
04/03/2020
Last updated
08/31/2022
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