Provider Demographics
NPI:1659050367
Name:MEHTA, LAUREN (MS, RD, LD, CDN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MS, RD, LD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2329
Mailing Address - Country:US
Mailing Address - Phone:678-719-2685
Mailing Address - Fax:
Practice Address - Street 1:5600 ROSWELL RD BLDG C
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1194
Practice Address - Country:US
Practice Address - Phone:678-719-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005753133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered