Provider Demographics
NPI:1457440786
Name:REDDEN, AMANDA JO (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:REDDEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5551
Mailing Address - Country:US
Mailing Address - Phone:404-422-5151
Mailing Address - Fax:770-949-8406
Practice Address - Street 1:22 CAMDEN CIR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5551
Practice Address - Country:US
Practice Address - Phone:404-422-5151
Practice Address - Fax:770-949-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003002133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal