Provider Demographics
NPI:1104836162
Name:CARO, CRISTINA MICHELLE (MBA, RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:CRISTINA
Middle Name:MICHELLE
Last Name:CARO
Suffix:
Gender:F
Credentials:MBA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 WINESAP DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1439
Mailing Address - Country:US
Mailing Address - Phone:678-234-0225
Mailing Address - Fax:
Practice Address - Street 1:775 WEST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3481
Practice Address - Country:US
Practice Address - Phone:678-234-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBQSMedicare ID - Type Unspecified
GAQ44247Medicare UPIN