Provider Demographics
NPI:1083207948
Name:MACKLIN, ATLANTA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ATLANTA
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4333
Mailing Address - Country:US
Mailing Address - Phone:210-439-1714
Mailing Address - Fax:830-730-5652
Practice Address - Street 1:2115 STEPHENS PL STE 400B
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2167
Practice Address - Country:US
Practice Address - Phone:210-439-1714
Practice Address - Fax:830-730-5652
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT86780OtherLICENSE