Provider Demographics
NPI:1518406842
Name:TOLBERT, COREY ANN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ANN
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:ANN
Other - Last Name:CASSISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:20 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-2358
Mailing Address - Country:US
Mailing Address - Phone:770-855-5903
Mailing Address - Fax:
Practice Address - Street 1:20 CHARLESTON DR
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276
Practice Address - Country:US
Practice Address - Phone:770-855-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered