Provider Demographics
NPI:1548605637
Name:ATWOOD, SUSAN M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:469-800-2100
Mailing Address - Fax:469-800-2155
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:469-800-2155
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXDT06563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290700YKY6Medicare PIN