Provider Demographics
NPI:1518128859
Name:BENARDOT, DAN S (PHD, RD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:S
Last Name:BENARDOT
Suffix:
Gender:M
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 2-107
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-567-5029
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 2-107
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-567-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000461133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD000461OtherSTATE OF GEORGIA LICENSED DIETITIAN