Provider Demographics
NPI:1164658282
Name:ANDRIST, SARA (MPH, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:ANDRIST
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CARTER AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-3244
Mailing Address - Country:US
Mailing Address - Phone:678-313-8323
Mailing Address - Fax:
Practice Address - Street 1:424 CARTER AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3244
Practice Address - Country:US
Practice Address - Phone:678-313-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered