Provider Demographics
NPI:1326396680
Name:SKIPPER-HARRILSON, TORRIE SHAPALE (MA, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:TORRIE
Middle Name:SHAPALE
Last Name:SKIPPER-HARRILSON
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:MS
Other - First Name:TORRIE
Other - Middle Name:SHAPALE
Other - Last Name:SKIPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,RD,LD
Mailing Address - Street 1:916 MOONLIT CRES
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7629
Mailing Address - Country:US
Mailing Address - Phone:678-641-5887
Mailing Address - Fax:
Practice Address - Street 1:916 MOONLIT CRES
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7629
Practice Address - Country:US
Practice Address - Phone:678-641-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered