Provider Demographics
NPI:1124181706
Name:LIVELY, RHONDA R (RD, LD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:LIVELY
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-0897
Mailing Address - Country:US
Mailing Address - Phone:770-339-4260
Mailing Address - Fax:
Practice Address - Street 1:5342 LAWRENCEVILLE HWY NW
Practice Address - Street 2:STE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5952
Practice Address - Country:US
Practice Address - Phone:678-924-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002321133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered