Provider Demographics
NPI:1578140810
Name:AUSTIN, GEORGIA DEANE (CNS, CCN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:DEANE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CNS, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 GLENCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2304
Mailing Address - Country:US
Mailing Address - Phone:315-663-4944
Mailing Address - Fax:315-682-0804
Practice Address - Street 1:4500 PEWTER LN BLDG 8&9
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9707
Practice Address - Country:US
Practice Address - Phone:315-663-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist