Provider Demographics
NPI:1083295901
Name:NARAYANASWAMY, DEEPALAKSHMI JAYARAMAN (RD LD)
Entity Type:Individual
Prefix:
First Name:DEEPALAKSHMI
Middle Name:JAYARAMAN
Last Name:NARAYANASWAMY
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 1:3635 EVONDALE GLENN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:470-297-7020
Mailing Address - Fax:
Practice Address - Street 1:3135 MATHIS AIRPORT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9134
Practice Address - Country:US
Practice Address - Phone:678-250-3438
Practice Address - Fax:866-850-2765
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered