Provider Demographics
NPI:1326214446
Name:MELTON, TAMARA (RD, LD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MELTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:BUSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE STE 3861
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:677-490-5991
Mailing Address - Fax:
Practice Address - Street 1:3225 CUMBERLAND BLVD SE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6408
Practice Address - Country:US
Practice Address - Phone:678-490-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered