Organization
NUTRISOURCE NUTRITIONAL SERVICES, INC.
Active
Other names
NutriSource, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAUREN G. BAILEY R.D. (OWNER)
(912) 222-7755
Entity
Organization
Contact information
Practice address
504 BEACHVIEW DR, SUITE 2A, SAINT SIMONS ISLAND, GA 31522-4740
(912) 222-7755
(912) 434-7018
Mailing address
620 SEA ISLAND RD, PMB 273, SAINT SIMONS ISLAND, GA 31522-1767
(912) 222-7755
(912) 434-7018
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002579
GA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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