Provider Demographics
NPI:1033716774
Name:BAGGA, SHANNON BUSBY (RDN, LD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BUSBY
Last Name:BAGGA
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:BUSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:1806 DEKALB AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:404-483-8946
Mailing Address - Fax:
Practice Address - Street 1:1806 DEKALB AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:404-483-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered