Provider Demographics
NPI:1407616931
Name:DEVINE, CORNELE (RDN)
Entity Type:Individual
Prefix:
First Name:CORNELE
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DURAND DR APT 22
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30750-2707
Mailing Address - Country:US
Mailing Address - Phone:423-244-8534
Mailing Address - Fax:
Practice Address - Street 1:300 DURAND DR APT 22
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30750-2707
Practice Address - Country:US
Practice Address - Phone:423-244-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006870133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered