Provider Demographics
NPI:1760759716
Name:MAGGIONI, LORI WALKER (MS, RDN, CSP, LD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:WALKER
Last Name:MAGGIONI
Suffix:
Gender:F
Credentials:MS, RDN, CSP, LD
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:KATHERINE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:770-713-3913
Mailing Address - Fax:
Practice Address - Street 1:300 EAST HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:770-713-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered