Provider Demographics
NPI:1619525334
Name:THRIVE NUTRITION, LLC
Entity Type:Organization
Organization Name:THRIVE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:404-376-1496
Mailing Address - Street 1:4729 MOCKERNUT CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4366
Mailing Address - Country:US
Mailing Address - Phone:404-376-1496
Mailing Address - Fax:
Practice Address - Street 1:4729 MOCKERNUT CT SW
Practice Address - Street 2:NONE
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3004
Practice Address - Country:US
Practice Address - Phone:404-376-1496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty