Provider Demographics
NPI:1669630778
Name:SAXTON, REGINA MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:SAXTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:MERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 3142
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0988
Mailing Address - Country:US
Mailing Address - Phone:678-372-2346
Mailing Address - Fax:
Practice Address - Street 1:2565 THOMPSON BRIDGE RD STE 111
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:678-372-2346
Practice Address - Fax:833-293-2482
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered