Provider Demographics
NPI:1073395398
Name:GODFREY, MEREDITH PEIRCE (MS, RD, IBCLC, LD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PEIRCE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MS, RD, IBCLC, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 BUCKLEY TRL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3484
Mailing Address - Country:US
Mailing Address - Phone:404-578-1386
Mailing Address - Fax:
Practice Address - Street 1:2030 BUCKLEY TRL
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3484
Practice Address - Country:US
Practice Address - Phone:404-578-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004353133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered