Provider Demographics
NPI:1629441589
Name:RAVELLO, GAIL (PHD , IMD, ND)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:RAVELLO
Suffix:
Gender:F
Credentials:PHD , IMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 SUN VALLEY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5690
Mailing Address - Country:US
Mailing Address - Phone:770-674-6311
Mailing Address - Fax:888-551-2391
Practice Address - Street 1:490 SUN VALLEY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5642
Practice Address - Country:US
Practice Address - Phone:770-674-6311
Practice Address - Fax:888-551-2391
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-6874975133NN1002X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education