Provider Demographics
NPI:1447613914
Name:NUTRITION SERVICE SPECIALISTS LLC
Entity Type:Organization
Organization Name:NUTRITION SERVICE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:GAROFALO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, RD/LD
Authorized Official - Phone:770-703-5053
Mailing Address - Street 1:1306 LAYOR CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1876
Mailing Address - Country:US
Mailing Address - Phone:770-703-5053
Mailing Address - Fax:770-703-5053
Practice Address - Street 1:1306 LAYOR CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1876
Practice Address - Country:US
Practice Address - Phone:770-703-5053
Practice Address - Fax:770-703-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty