Provider Demographics
NPI:1235378639
Name:BLISSFUL LIVING
Entity Type:Organization
Organization Name:BLISSFUL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DHANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD,LD
Authorized Official - Phone:404-273-5704
Mailing Address - Street 1:165 DEKALB INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2230
Mailing Address - Country:US
Mailing Address - Phone:404-273-5704
Mailing Address - Fax:
Practice Address - Street 1:165 DEKALB INDUSTRIAL WAY
Practice Address - Street 2:B7
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2230
Practice Address - Country:US
Practice Address - Phone:404-273-5704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001559133N00000X, 133NN1002X, 133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty