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Individual

SUSAN HERRLICH SHACKLETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
808 PROFESSIONAL BLVD, DALTON, GA 30720-2536
(706) 281-2228
Mailing address
801 ATKINSON DR, DALTON, GA 30720-3901
(706) 275-0734

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1856
TN
133V00000X
Registered Dietitian
47092D
133V00000X
Registered Dietitian
Primary
LD002865
GA

Other

Enumeration date
05/09/2007
Last updated
07/08/2007
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