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Individual

ELLEN SURATT STANBACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD,LD,CLC

Contact information

Practice address
2277 STONE MOUNTAIN LITHONIA RD, LITHONIA, GA 30058-5252
(770) 484-2600
(770) 484-3830
Mailing address
3177 KENSINGTON RD, AVONDALE ESTATES, GA 30002-1457
(404) 299-1150

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD001907
GA

Other

Enumeration date
10/25/2006
Last updated
07/08/2007
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