Provider Demographics
NPI:1598794497
Name:DIETITIAN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DIETITIAN ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:901-759-9337
Mailing Address - Street 1:2065 FENNELL PL
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-7400
Mailing Address - Country:US
Mailing Address - Phone:901-759-9337
Mailing Address - Fax:901-759-7967
Practice Address - Street 1:2065 FENNELL PL
Practice Address - Street 2:
Practice Address - City:NESBIT
Practice Address - State:MS
Practice Address - Zip Code:38651-7400
Practice Address - Country:US
Practice Address - Phone:901-759-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty