Provider Demographics
NPI:1861845869
Name:HEIGHT, GALE OCTAVIA
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:OCTAVIA
Last Name:HEIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GALE
Other - Middle Name:OCTAVIA
Other - Last Name:HEIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2222 E WEST CONNECTOR
Mailing Address - Street 2:APT 311N
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8190
Mailing Address - Country:US
Mailing Address - Phone:770-805-0774
Mailing Address - Fax:678-310-0394
Practice Address - Street 1:2222 E WEST CONNECTOR
Practice Address - Street 2:311N
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8190
Practice Address - Country:US
Practice Address - Phone:770-905-0774
Practice Address - Fax:678-310-0394
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered