Provider Demographics
NPI:1265970925
Name:ELLENBERG, CHRISTINA (RD, LDN, CSCS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ELLENBERG
Suffix:
Gender:F
Credentials:RD, LDN, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 GALAHAD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3627
Mailing Address - Country:US
Mailing Address - Phone:704-351-1552
Mailing Address - Fax:
Practice Address - Street 1:2692 GALAHAD DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3627
Practice Address - Country:US
Practice Address - Phone:704-351-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008727133V00000X
GALD004769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered