Provider Demographics
NPI:1619697398
Name:ROMANO, NATALIE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ROMANO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ROMANO
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-8169
Mailing Address - Fax:
Practice Address - Street 1:1446 HARPER ST # BP3252
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0012
Practice Address - Country:US
Practice Address - Phone:706-721-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD005933OtherLICENSE