Provider Demographics
NPI:1669035234
Name:REDMOND, ELIZABETH HOLLY (PHD, RDN)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HOLLY
Last Name:REDMOND
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2743
Mailing Address - Country:US
Mailing Address - Phone:404-394-5997
Mailing Address - Fax:
Practice Address - Street 1:1201 W PEACHTREE ST STE 2312
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3449
Practice Address - Country:US
Practice Address - Phone:404-394-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered