Provider Demographics
NPI:1326479262
Name:SCHOLLE, LORI ANN (MS, RDN, LD, CBS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:SCHOLLE
Suffix:
Gender:F
Credentials:MS, RDN, LD, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1623
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1623
Mailing Address - Country:US
Mailing Address - Phone:404-566-4538
Mailing Address - Fax:404-566-4538
Practice Address - Street 1:615 PONCE DE LEON PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5108
Practice Address - Country:US
Practice Address - Phone:404-566-4538
Practice Address - Fax:404-566-4539
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004058133V00000X, 133VN1004X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No174N00000XOther Service ProvidersLactation Consultant, Non-RN