Provider Demographics
NPI:1417169905
Name:GILES, COURTNEY BLAIR (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BLAIR
Last Name:GILES
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MRS
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:854 STOKESWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316
Mailing Address - Country:US
Mailing Address - Phone:404-281-5823
Mailing Address - Fax:
Practice Address - Street 1:1258 DEKALB AVENUE
Practice Address - Street 2:#124
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:404-307-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered