Organization
BODY FOR LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY ANN PAINE RD, LD (OWNER)
(678) 773-1853
Entity
Organization
Contact information
Practice address
136 E RIVER BEND DR, EATONTON, GA 31024-5353
(678) 773-1853
Mailing address
136 E RIVER BEND DR, EATONTON, GA 31024-5353
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0107063
GA
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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