Provider Demographics
NPI:1811540297
Name:MIDDLE GEORGIA NUTRITION CONSULTING, LLC
Entity Type:Organization
Organization Name:MIDDLE GEORGIA NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:678-372-5534
Mailing Address - Street 1:232 RIVER NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6038
Mailing Address - Country:US
Mailing Address - Phone:678-372-5534
Mailing Address - Fax:
Practice Address - Street 1:1209 N COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2395
Practice Address - Country:US
Practice Address - Phone:678-372-5534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center