Provider Demographics
NPI:1407335243
Name:KLEIN, ANNMARIE SUZETTE (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANNMARIE
Middle Name:SUZETTE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 SAGE LN NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3240
Mailing Address - Country:US
Mailing Address - Phone:770-355-7427
Mailing Address - Fax:
Practice Address - Street 1:872 SAGE LN NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3240
Practice Address - Country:US
Practice Address - Phone:770-355-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered