Provider Demographics
NPI:1477259307
Name:VANIS, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 ASHFORD DUNWOODY RD NE UNIT 1023
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2065
Mailing Address - Country:US
Mailing Address - Phone:404-421-0064
Mailing Address - Fax:
Practice Address - Street 1:3650 ASHFORD DUNWOODY RD NE UNIT 1023
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2065
Practice Address - Country:US
Practice Address - Phone:404-421-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered