Provider Demographics
NPI:1083476741
Name:REEVES, LORA GAHAGAN EDDY (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:GAHAGAN EDDY
Last Name:REEVES
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:GAHAGAN
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 MCINTOSH ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3010
Mailing Address - Country:US
Mailing Address - Phone:843-685-2058
Mailing Address - Fax:
Practice Address - Street 1:600 CELEBRATE LIFE PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8001
Practice Address - Country:US
Practice Address - Phone:843-685-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered