Individual
JERRI K AULTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1007 GREENFIELD DR, TIFTON, GA 31794-3795
(229) 382-9733
Mailing address
1007 GREENFIELD DR, TIFTON, GA 31794-3795
(229) 382-9733
(229) 387-6161
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD001366
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834511
REGISTERED DIETITIAN
GA
01
—
LD001366
STATE LICENSE
GA
Enumeration date
12/29/2010
Last updated
10/18/2022
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