Provider Demographics
NPI:1467565200
Name:SEYBOLD, DARRIN O (MS, RD)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:O
Last Name:SEYBOLD
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 103-38
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4471
Mailing Address - Country:US
Mailing Address - Phone:404-674-5458
Mailing Address - Fax:
Practice Address - Street 1:140 KETTON WAY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6481
Practice Address - Country:US
Practice Address - Phone:404-674-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002105133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered