Provider Demographics
NPI:1346601655
Name:PLUSH, COURTNEY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PLUSH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PEACHTREE VALLEY RD NE
Mailing Address - Street 2:APT 1605
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1411
Mailing Address - Country:US
Mailing Address - Phone:610-506-0643
Mailing Address - Fax:
Practice Address - Street 1:40 PEACHTREE VALLEY RD NE
Practice Address - Street 2:APT 1605
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1411
Practice Address - Country:US
Practice Address - Phone:610-506-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered