Provider Demographics
NPI:1033230719
Name:LUTTERBIE, CYNTHIA (RD LD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LUTTERBIE
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 PLANTATION TRACE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6326
Mailing Address - Country:US
Mailing Address - Phone:404-303-6161
Mailing Address - Fax:404-257-2184
Practice Address - Street 1:330 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4128
Practice Address - Country:US
Practice Address - Phone:404-303-6161
Practice Address - Fax:404-257-2184
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered