Provider Demographics
NPI:1003409558
Name:CAMPBELL, ADRIENNE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CHATTANOOGA AVE APT A306
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8887
Mailing Address - Country:US
Mailing Address - Phone:678-982-7584
Mailing Address - Fax:
Practice Address - Street 1:801 CHATTANOOGA AVE APT A306
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8887
Practice Address - Country:US
Practice Address - Phone:678-982-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered