Provider Demographics
NPI:1598794604
Name:NUTRITION CONSULTANTS OF ATLANTA, LLC
Entity Type:Organization
Organization Name:NUTRITION CONSULTANTS OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:678-207-9139
Mailing Address - Street 1:1105 CHIPWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1434
Mailing Address - Country:US
Mailing Address - Phone:404-664-3219
Mailing Address - Fax:770-723-1397
Practice Address - Street 1:1105 CHIPWOOD PATH
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1434
Practice Address - Country:US
Practice Address - Phone:404-664-3219
Practice Address - Fax:770-723-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty