Individual
MRS. KIMBERLY DAWN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.
Contact information
Practice address
6073 AUTUMN VIEW TRL NW, ACWORTH, GA 30101-7685
(770) 917-9449
Mailing address
6073 AUTUMN VIEW TRL NW, ACWORTH, GA 30101-7685
(770) 917-9449
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD001807
GA
Other
Enumeration date
02/01/2011
Last updated
02/01/2011
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