Provider Demographics
NPI:1285041947
Name:LEMON, MARY BETH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:LEMON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 REVELATION WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7894
Mailing Address - Country:US
Mailing Address - Phone:704-517-9056
Mailing Address - Fax:803-286-5418
Practice Address - Street 1:1833 PAGELAND HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7606
Practice Address - Country:US
Practice Address - Phone:803-285-7628
Practice Address - Fax:803-286-5418
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC308133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered