Provider Demographics
NPI:1851057251
Name:MEYER, ALISA (LDN)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 LAUREL SUMMIT DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4331
Mailing Address - Country:US
Mailing Address - Phone:704-785-4197
Mailing Address - Fax:
Practice Address - Street 1:1253 LAUREL SUMMIT DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4331
Practice Address - Country:US
Practice Address - Phone:704-785-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD-P000290133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education