Provider Demographics
NPI:1174043673
Name:RACHEL BRANDEIS REGISTERED DIETITIAN LLC
Entity Type:Organization
Organization Name:RACHEL BRANDEIS REGISTERED DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-752-4984
Mailing Address - Street 1:400 PERIMETER CENTER TER NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4740
Practice Address - Country:US
Practice Address - Phone:770-752-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty