Provider Demographics
NPI:1497169189
Name:CUCULOVSKI, KRISTIN DUGGER (RDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DUGGER
Last Name:CUCULOVSKI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FY RD NE STE D250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1646
Mailing Address - Country:US
Mailing Address - Phone:404-236-8028
Mailing Address - Fax:
Practice Address - Street 1:2030 POWERS FERRY RD SE STE 325
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5065
Practice Address - Country:US
Practice Address - Phone:404-987-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004247133V00000X
GA4247
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered