Provider Demographics
NPI:1437935996
Name:NOSIRI, ALEXIS ADAURE (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ADAURE
Last Name:NOSIRI
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 GOSSAMER ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-5197
Mailing Address - Country:US
Mailing Address - Phone:404-396-7617
Mailing Address - Fax:
Practice Address - Street 1:200 TRILITH PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4462
Practice Address - Country:US
Practice Address - Phone:770-719-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5961133V00000X
GA86153194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered