Provider Demographics
NPI:1093592891
Name:GALLAHER, VIDA JEAN (RDN)
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:JEAN
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:VIDA
Other - Middle Name:JEAN
Other - Last Name:HARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1353 N CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3852
Mailing Address - Country:US
Mailing Address - Phone:865-466-9890
Mailing Address - Fax:
Practice Address - Street 1:6401 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5406
Practice Address - Country:US
Practice Address - Phone:423-893-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4195133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered