Provider Demographics
NPI:1578843215
Name:VIKHROV, TOMEKIA L (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TOMEKIA
Middle Name:L
Last Name:VIKHROV
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:TOMEKIA
Other - Middle Name:L
Other - Last Name:BATTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6707
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-6707
Practice Address - Fax:912-435-6791
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered