Provider Demographics
NPI:1619945482
Name:BIGNOTTI, SARAH GENDREAU (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GENDREAU
Last Name:BIGNOTTI
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 HIGHBROOKE TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2236
Mailing Address - Country:US
Mailing Address - Phone:770-232-0815
Mailing Address - Fax:
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:678-584-7660
Practice Address - Fax:678-584-7679
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6635Medicare ID - Type Unspecified