Provider Demographics
NPI:1417077306
Name:LEON, RACHEL (RD, LD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 PEACHTREE HOLLOW CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1643
Mailing Address - Country:US
Mailing Address - Phone:404-303-3791
Mailing Address - Fax:404-303-3793
Practice Address - Street 1:515 FAIRBURN RD SW STE 350
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2012
Practice Address - Country:US
Practice Address - Phone:404-505-6754
Practice Address - Fax:404-505-6758
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered