Provider Demographics
NPI:1598149783
Name:MARC, LOICA CHRISTINA (RD)
Entity Type:Individual
Prefix:
First Name:LOICA
Middle Name:CHRISTINA
Last Name:MARC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WINDY HILL RD
Mailing Address - Street 2:SUITE 300 PMB 5202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1739
Mailing Address - Country:US
Mailing Address - Phone:770-861-9176
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD
Practice Address - Street 2:SUITE 300 PMB 5202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1739
Practice Address - Country:US
Practice Address - Phone:770-861-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004458133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered