Provider Demographics
NPI:1225299555
Name:BENARDOT NUTRITION, LLC
Entity Type:Organization
Organization Name:BENARDOT NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BENARDOT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:404-567-5029
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 2-107
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-567-5029
Mailing Address - Fax:404-601-5484
Practice Address - Street 1:5825 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 2-107
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-567-5029
Practice Address - Fax:404-601-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty