Provider Demographics
NPI:1710344569
Name:CALLAHAN, JULIA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WENTWORTH DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7120
Mailing Address - Country:US
Mailing Address - Phone:404-861-0052
Mailing Address - Fax:404-793-6712
Practice Address - Street 1:375 WENTWORTH DOWNS CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7120
Practice Address - Country:US
Practice Address - Phone:404-861-0052
Practice Address - Fax:404-793-6712
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered