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Individual

MARY LOUISE SLULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
R.D., LD, MA

Contact information

Practice address
2361 TOBACCO RD, AUGUSTA, GA 30906-9220
(706) 793-4401
(706) 790-4372
Mailing address
3522 HILLTOP DR, AUGUSTA, GA 30906-5732
(706) 796-8739
(706) 796-6075

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD000433
GA

Other

Enumeration date
04/26/2007
Last updated
07/08/2007
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