Provider Demographics
NPI:1407367865
Name:ELITE NUTRITION CONSULTING, LLC
Entity Type:Organization
Organization Name:ELITE NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN,LD
Authorized Official - Phone:931-703-1627
Mailing Address - Street 1:1765 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-3013
Mailing Address - Country:US
Mailing Address - Phone:931-703-1627
Mailing Address - Fax:
Practice Address - Street 1:1805 N JACKSON ST STE 6
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2275
Practice Address - Country:US
Practice Address - Phone:931-703-1627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty