Provider Demographics
NPI:1235732298
Name:REID, MELISSA (RDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 OBRIEN LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2760
Mailing Address - Country:US
Mailing Address - Phone:979-676-2369
Mailing Address - Fax:
Practice Address - Street 1:495 DANCE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-4017
Practice Address - Country:US
Practice Address - Phone:979-676-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered