Provider Demographics
NPI:1194179416
Name:DIETITIANS DIRECT LLC
Entity Type:Organization
Organization Name:DIETITIANS DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:770-335-7335
Mailing Address - Street 1:212 WASHINGTON AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:770-335-7335
Mailing Address - Fax:
Practice Address - Street 1:212 WASHINGTON AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:770-335-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1031418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty