Provider Demographics
NPI:1558124792
Name:RYS, BROOKE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:RYS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 RIVER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-1520
Mailing Address - Country:US
Mailing Address - Phone:404-416-6299
Mailing Address - Fax:
Practice Address - Street 1:1955 RIVER FOREST DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-1520
Practice Address - Country:US
Practice Address - Phone:404-416-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA933059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty