Provider Demographics
NPI:1730304726
Name:COVEY, CAROLYN RENEE (RD,LD,CDE)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RENEE
Last Name:COVEY
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 CROFTON OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1949
Mailing Address - Country:US
Mailing Address - Phone:770-559-1659
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3301
Practice Address - Country:US
Practice Address - Phone:678-442-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered