Individual
CHANDRA BIVENS CARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
1516 ROCK QUARRY RD, STOCKBRIDGE, GA 30281-5047
(770) 389-0836
(770) 389-0886
Mailing address
2605 BRUSHY NOB LN, STOCKBRIDGE, GA 30281-5243
(770) 389-0836
(770) 389-0886
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD000618
GA
133VN1004X
Pediatric Nutrition Registered Dietitian
LD000618
GA
133VN1005X
Renal Nutrition Registered Dietitian
LD000618
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
691002664A
—
GA
Enumeration date
09/13/2006
Last updated
11/04/2011
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