Provider Demographics
NPI:1508310434
Name:FARMER, HEATHER (RD, LDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7299
Mailing Address - Country:US
Mailing Address - Phone:770-328-7444
Mailing Address - Fax:
Practice Address - Street 1:397 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7299
Practice Address - Country:US
Practice Address - Phone:770-328-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86003186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered