Provider Demographics
NPI:1013592682
Name:PRICE, OLIVIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PRICE
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 1:6263 RIVOLI DR APT 104
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4777
Mailing Address - Country:US
Mailing Address - Phone:865-209-5525
Mailing Address - Fax:
Practice Address - Street 1:1501 RIVERSIDE DR STE 340
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-4309
Practice Address - Country:US
Practice Address - Phone:865-209-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3988133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered