Provider Demographics
NPI:1497346621
Name:ENGSTROM, CHRISTINE ALICIA (MS,RDN,LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALICIA
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:MS,RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHAUMONT SQ NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1076
Mailing Address - Country:US
Mailing Address - Phone:404-277-5764
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE FORREST DR STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3837
Practice Address - Country:US
Practice Address - Phone:404-343-4162
Practice Address - Fax:404-549-9316
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty