Provider Demographics
NPI:1790396570
Name:FALCON, STEPHANIE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4220
Mailing Address - Country:US
Mailing Address - Phone:678-886-9100
Mailing Address - Fax:
Practice Address - Street 1:415 COTTONWOOD CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4220
Practice Address - Country:US
Practice Address - Phone:678-886-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered