Provider Demographics
NPI:1043820624
Name:EAT GOOD, FEEL GOOD LLC
Entity Type:Organization
Organization Name:EAT GOOD, FEEL GOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:862-268-4375
Mailing Address - Street 1:2850 IRWIN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8470
Mailing Address - Country:US
Mailing Address - Phone:862-268-4375
Mailing Address - Fax:
Practice Address - Street 1:2850 IRWIN DR
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8470
Practice Address - Country:US
Practice Address - Phone:862-268-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty