Provider Demographics
NPI:1659732873
Name:NOOROMID NUTRITION LLC
Entity Type:Organization
Organization Name:NOOROMID NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOROMID
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:770-971-9234
Mailing Address - Street 1:974 SAINT LYONN CTS
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4532
Mailing Address - Country:US
Mailing Address - Phone:770-971-9234
Mailing Address - Fax:770-640-0222
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4740
Practice Address - Country:US
Practice Address - Phone:770-971-9234
Practice Address - Fax:770-640-0222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOOROMID NUTRITION CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBQVMedicare UPIN