Provider Demographics
NPI:1639542665
Name:SUDDRETH, BETHANY MOTES (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MOTES
Last Name:SUDDRETH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:MOTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2440
Practice Address - Country:US
Practice Address - Phone:864-675-3488
Practice Address - Fax:864-627-9131
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004464133V00000X
SC1685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered