Provider Demographics
NPI:1508585597
Name:STURGILL, ALISON COLEMAN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:COLEMAN
Last Name:STURGILL
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 SWAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1528
Mailing Address - Country:US
Mailing Address - Phone:502-645-0746
Mailing Address - Fax:
Practice Address - Street 1:615 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2309
Practice Address - Country:US
Practice Address - Phone:404-251-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095802OtherCOMMISSION ON DIETETIC REGISTRATION
GALD004070OtherGEORGIA BOARD OF EXAMINERS OF LICENSED DIETITIANS