Provider Demographics
NPI:1033540547
Name:SUMMERS, HEATHER (RD, LD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SUMMERS
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 1:211 AUGUSTA ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631
Mailing Address - Country:US
Mailing Address - Phone:864-654-7156
Mailing Address - Fax:
Practice Address - Street 1:211 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1951
Practice Address - Country:US
Practice Address - Phone:864-654-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC285133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered