Individual
MARY MICHELLE CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
262 RIDGEWOOD DR, WALESKA, GA 30183-3942
(404) 290-6130
Mailing address
262 RIDGEWOOD DR, WALESKA, GA 30183-3942
(404) 290-6130
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
01/26/2023
Last updated
01/26/2023
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