Provider Demographics
NPI:1619532090
Name:HARRIS, MELANIE HOLLINGSWORTH (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:HOLLINGSWORTH
Last Name:HARRIS
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:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1283
Mailing Address - Country:US
Mailing Address - Phone:912-294-2570
Mailing Address - Fax:
Practice Address - Street 1:2119 EASTLAKE DR
Practice Address - Street 2:
Practice Address - City:SCREVEN
Practice Address - State:GA
Practice Address - Zip Code:31560-9721
Practice Address - Country:US
Practice Address - Phone:912-294-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered