Provider Demographics
NPI:1891850657
Name:NOOROMID, SAFA (RD,LD)
Entity Type:Individual
Prefix:PROF
First Name:SAFA
Middle Name:
Last Name:NOOROMID
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 SAINT LYONN CTS
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4532
Mailing Address - Country:US
Mailing Address - Phone:770-971-9234
Mailing Address - Fax:770-640-0222
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4740
Practice Address - Country:US
Practice Address - Phone:770-971-9234
Practice Address - Fax:770-640-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002716133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBQVMedicare ID - Type UnspecifiedMNT